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Anatomy and CT Three-dimensional Reconstruction of the Left Hepatic Vein for Application in Children Living Donor Liver Transplantation

Author: LiYanYan
Tutor: QianXueHua
School: Chongqing Medical University
Course: Human Anatomy,Histology and Embryology
Keywords: Left hepatic vein Dissection 64-MSCT Living donor liver transplantation Three-dimensional reconstruction
CLC: R726.5
Type: Master's thesis
Year: 2010
Downloads: 30
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Abstract


Purpose and significance of the liver transplant technology and peri-surgical treatment are maturing, liver transplantation has become the treatment of end-stage liver disease is recognized as an effective means; especially living donor liver transplantation (Living donor liver transplantation, LDLT) Activities to address children liver lack of hepatic graft (usually provided by their parents), children LDLT adult liver left lateral or left liver can meet the needs of infants less than 1 year old, only a liver segment can meet their donor liver required to ensure the safety of the donor's. However, the intrahepatic vessels running complex, more variation, caused great difficulties to some LDLT preoperative acquire accurate and detailed information of the anatomy of the intrahepatic duct system, LDLT prerequisite for success; mentioned earlier children LDLT involves only even outside of the left lobe of the liver, the left lateral lobe following paragraph, it is of great value to the left hepatic vein (Left hepatic vein, LHV) in pediatric LDLT master of LHV's anatomy data helps children with partial LDLT choice of surgical procedure and receptor hepatic vein reconstruction. This study gross anatomy with MSCT image contrast observation of LHV its tributaries the morphological law and the relevant data, and to provide for the children's section LDLT LHV morphological data; rebuilt based on the use of three-dimensional computer reconstruction software three-dimensional model of the liver and hepatic vein, and intends to do a preliminary exploration of the the LDLT virtual surgery. Materials and Methods 1. Anatomical peel 50 adult patients without the lesions corpse liver hepatic vein, of LHV observations, collecting data for statistical analysis. 2. Collected data of 100 patients without liver disease of adults 64-MSCT enhanced scan hepatic vein, CT comes with GE ADW 4.2 workstation three-dimensional reconstruction of the hepatic vein, observing LHV collect relevant data for statistical analysis, and combined gross anatomical specimens the The measured results were analyzed. Selection of live donor liver 64-MSCT enhancement scan data using Mimics 3D reconstruction software, reconstruction of three-dimensional model of the liver and hepatic veins. Results of the first part of the left hepatic vein general and CT anatomy (1), LHV, MHV common trunk and opening Specimens LHV and MHV total dry by 80.00% and 77.50% of the opening 1:00 bit parts on IVC liver after paragraph 20.00% opening at 2:00 bit; LHV, MHV total LHV separate opening by 20.00%, 80.00% opening at 2:00, 20.00% opening at 3:00; LHV and MHV opening pitch is (2.00 ± 1.15) mm; the dry vessel length (5.09 ± 2.78) mm, and its ending point at (12.02 ± 1.91) mm in diameter. 59.00%, of the the the CT specimens LHV and MHV total dry by opening at IVC liver segment parts 1:00 and 1:30 are 44.07%; the LHV separate openings by 41.00%, 46.34% opening at 2:00 53.66% opening at 3:00 bit; LHV and MHV opening pitch to (4.73 ± 2.75) mm; LHV, MHV total dry the vessel length (7.68 ± 2.97) mm, and its ending point at (11.56 ± 2.04) mm in diameter . (2) LHV extrahepatic segment, surgical dry and trunk length measured specimens the LHV extrahepatic segment length (9.89 ± 4.86) mm. Specimens and CT specimens the LHV Total dry surgical stem length (13.75 ± 8.11) mm and (11.22 ± 7.34) mm longer than those separate openings (7.85 ± 8.61) mm and (5.89 ± 6.53) mm ( P lt; 0.05). Specimens and CT specimens LHV trunk length, respectively (39.1 ± 15.16) mm and (34.33 ± 12.66) mm; Specimens LHV trunk only point, midpoint, starting point diameter (8.44 ± 1.28) mm, (6.97 ± 1.56) mm and (6.39 ± 1.59) mm CT specimens corresponding data were (8.13 ± 1.60) mm, (6.67 ± 1.39) mm and (5.57 ± 1.33) mm. (3) LHV trunk vertical distance away from the diaphragmatic surface of the liver the gross specimen LHV backbone distance import IVC at 10mm, 20mm, 30mm, 40mm, and the trunk at the beginning of the upper wall of the diaphragmatic surface of the vertical distance to the liver (5.87 ± 3.85) mm , (12.80 ± 4.93) mm, (17.63 ± 5.06) mm, (20.73 ± 5.39) mm and (24.16 ± 5.91) mm CT specimens corresponding data were (8.42 ± 3.75) mm, (13.27 ± 5.01) mm, ( 18.43 ± 6.37) mm, (22.72 ± 8.49) mm and (28.66 ± 13.31) mm. (4) LHV trunk falciform ligament, the MHV trunk and IVC long axis of the angle specimens 96.00% LHV trunk in sickle ligament of the left side of the falciform ligament was (35.31 ± 16.79) ° angle, 2.00% parallel to falciform ligament of the left, and 2.00% in sickle the the ligament right side with sickle ligament angle was 35.00 °; specimens and CT specimens, the angle of LHV trunk with MHV trunk were (66.22 ± 18.80) ° and (67.96 ± 16.25) °; angle between the of the LHV trunk and IVC long axis were (67.08 ± 13.42) ° and (47.81 ± 16.26) °. (5) LHV tributaries based on LHV main branches of the amount of the LHV tributary divided into three types, the corresponding data in general and CT are two type: 0.00% and 3.00%, 3 type: 16.00% and 13.00 %, multivessel type: are 84.00%. Roughly specimens and CT specimens LHV main reflow liver Ⅱ, Ⅲ segment and part Ⅳ A IVB segment by, respectively, accounting for 46.00 and 36.00%, mainly reflow liver II, Ⅲ segment and part Ⅳ A segment by, respectively, accounting for 24.00% and 39.00%. The second part of the liver and the left hepatic vein Mimics study by Mimics established liver and hepatic vein outline of the three-dimensional model is smooth and clear, by adjusting the transparency of the liver, the liver and the hepatic vein can be displayed simultaneously. Can zoom in, zoom and rotate the model, such as full observation. Mimics Simulation Module can model any cutting, to simulate partial hepatectomy plane, and can automatically display resection or non-resection liver volume. The three-dimensional model of the image can be saved as BMP or JPEG format, or recording into AVI format movie output dynamic display its playback screen is clear and smooth. Conclusion 1. Utilize the Specimens and three-dimensional reconstruction of the 64-MSCTA LHV research can complement each other; CT findings consistent gross anatomical specimens observations, is a reliable clinical examination methods for LDLT preoperative LHV walk the line and its variability, donor selection guidance LDLT preoperative and intraoperative determine the cut plane and donor the LHV and receptor vein of anastomosis. LHV more with MHV common trunk injection IVC of its total dry vascular chunky, the LHV multi openings in the IVC retrohepatic segment of the upper left edge, LHV trunk line more than most over the split between the left lateral lobe segment convex to the left bow, LHV number of branches is not constant, most of them for four or five. . Enhanced liver CT scan data using Mimics software can quickly extract hepatic vein reconstruction of hepatic vein three-dimensional model, but more time-consuming for the segmentation of the liver; contribute to the reconstruction of three-dimensional model of the liver and liver vein anatomy teaching and the development of rational LDLT program, and laid the foundation for liver virtual surgery.

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CLC: > Medicine, health > Pediatrics > Pediatric surgery > Surgery in children of all physiological systems
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