中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (08): 917-922.DOI: 10.19538/j.cjps.issn1005-2208.2025.08.13

• 论著 • 上一篇    下一篇

基于CT三维可视化技术肝右前叶门静脉及前裂静脉解剖分型研究

李浩铭1，刘承利1,2,3，李璐阳1，杨    俊1，夏    添3，蒲    猛2，张书涵2，马英博2   

  1. 1中国医科大学空军特色医学中心肝胆外科，北京 100142；2 空军军医大学空军特色医学中心肝胆外科，北京 100142；3 河北北方学院空军特色医学中心肝胆外科，北京 100142
  • 出版日期:2025-08-01 发布日期:2025-09-02

  • Online:2025-08-01 Published:2025-09-02

摘要： 目的    基于CT三维可视化技术，对肝右前叶门静脉第三级分支、门静脉Ⅵ段腹侧支（P6a）及肝前裂静脉（AFV）进行分型统计与分析，为肝右前叶的解剖性区域划分提供依据。方法    回顾性分析2022年9月至2024年12月于空军特色医学中心肝胆外科进行上腹部增强CT的100例病人的影像学资料，对肝右前叶门静脉第三级分支的走行、类型，以及AFV的出现频率、分支汇入的静脉类型和汇入位置及门静脉Ⅵ段腹侧分支是否参与供应S5段进行分类与统计。结果    肝右前叶门静脉可分为头尾型（34.0%）、腹背型（32.0%）、三叉型（24.0%）和四分支型（10.0%）。AFV的总体检出率为89.0%。头尾型AFV检出率85.3%，腹背型93.8%，三分叉型87.5%，四分叉型90.0%，不同分型间AFV检出率（P=0.720）及AFV长度（P=0.097）差异无统计学意义。AFV单支型占51.0%，多支型38.0%，缺如型11.0%；60.8%（31/51）的AFV单支型病人AFV直径为2~4 mm，33.3%（17/51）的病人AFV直径≥4 mm。在AFV多支型病人中，所有病人均存在至少1条AFV直径≥2 mm。96.1%（124/129）的AFV汇入点位于肝静脉近端段（距下腔静脉≤5 cm），其中78.4%（40/51）单支型AFV集中汇入肝中或肝右静脉近端区域，45.1%（23/51）的单支型AFV以汇入肝中静脉近段前半部为主。结论    肝脏右前叶门静脉存在腹背分型，但该分型并非主导类型；基于门静脉血管支配特征，P6a区可归属于S5段；此外，AVF仅可作为界定S8段腹侧与背侧分界的可靠标志。

关键词: 肝右前叶, 三维可视化技术, 前裂静脉, 门静脉, 解剖分型 

Abstract: To provide a scientific basis for the anatomical regional division of the right anterior liver lobe via classification statistics and analysis of the third-level branches of the portal vein in the right anterior liver lobe, the ventral branch of segment Ⅵ (P6a), and the anterior fissure vein (AFV) based on CT three-dimensional visualization technology. Methods    Retrospective analysis was performed on imaging data from 100 patients who underwent contrast-enhanced upper abdominal CT scans at the Hepatobiliary Surgery Department of the Air Force Characteristic Medical Center between September 2022 and December 2024. The courses and types of third-order portal vein branches in the right anterior section, the detection frequency of the AFV, the types of hepatic veins it drained into, its drainage location, and whether the ventral branch of segment Ⅵ portal vein supplies segment S5. Results    The portal veins of the right anterior section were classified into four types: cephalocaudal (34.0%), dorsoventral (32.0%), trifurcation (24.0%), and quadrifurcation (10.0%). The overall detection rate of AFV was 89.0% (89/100). AFV detection rates were 85.3% in the cephalocaudal, 93.8% in the dorsoventral, 87.5% in the trifurcation, and 90.0% in the quadrifurcation, with no significant inter-group differences in detection rate (P=0.720) or length distribution (P=0.097) of AFV. Among the patients with single AFV trunk, 60.8% (31/51) had an AFV diameter of 2-3.9 mm, and 33.3% (17/51) had an AFV diameter of ≥ 4 mm. In patients with multiple AFV trunks, all had at least one AFV with a diameter of ≥ 2 mm. Anatomical localization revealed 96.1% (124/129) of AFV drainage points were in the proximal hepatic vein segment (≤5 cm from inferior vena cava). Among single-trunk AFV, 78.4% (40/51) drained into the proximal MHV/RHV region, with 45.1% (23/51) predominantly draining into the proximal anterior segment of MHV. Conclusion    While the dorso-ventral subdivision pattern exists in the portal vein in the right anterior lobe of the liver, it is not the dominant classification. Based on the characteristics of portal venous supply, subsegment P6a should be categorized within segment S5. Furthermore, the AVF serves as a reliable landmark for defining the boundary between the ventral and dorsal portions of S8.

Key words: right anterior hepatic lobe, three-dimensional visualization technology, anterior fissure vein, hepatic portal vein, anatomical classification