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Right superior resection (segments 7 and 8) is an uncommon resection for liver malignancies, with most of the literature limited to case reports and small series. Resection of segments 4, 7, and 8 has been reported in only a few cases. When the right hepatic vein is resected, venous reconstruction or identification of one or more right inferior hepatic veins is considered mandatory, to maintain segmentary function of segments 5 and 6. We present a case of liver resection of segments 4, 7, and 8 including the right and middle hepatic veins for symptomatic benign liver disease with no right hepatic vein reconstruction, nor a prominent right inferior hepatic vein(s). After the resection, there was no change in liver function tests, and the patient made an unremarkable recovery. Three months after the operation, partial atrophy of segments 5 and 6 with hypertrophy of the left lateral section was observed, while two and one half years after resection, the patient is asymptomatic. When right hepatic vein reconstruction would add unnecessary operative time, and there is low likelihood of the need for repeated resection, particularly when the hepatic vein is difficult to dissect, this approach can be safe and useful, while providing an adequate postoperative liver mass in the short-term to recover uneventfully from major liver resection.

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Cholangiocarcinoma is a heterogeneous group of aggressive tumors that correspond to the second most common primary liver tumor. They can be classified according to their anatomical position concerning the biliary tree, and each subtype demonstrates different behavior and treatment. A 38-year-old male patient presenting solely right lumbar pain was diagnosed with a 7 cm hepatic tumor involving segments I, Iva, and VIII associated with involvement of the hepatic veins. He underwent a bloc resection of hepatic segments I, II, III, IV, partial V, partial VII, and VIII; right, middle, and left hepatic veins; and inferior vena cava segment, with perfusion of the remaining liver in situ with a preservation solution. As the patient had a large accessory inferior right hepatic vein draining the remaining liver, no reimplantation of hepatic veins was necessary. He remained clinically stable in outpatient follow-up, with excellent performance status-current survival of 2 years 6 months after surgical treatment.

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A totally implantable venous access port (TIVAP) is used for chemotherapy administration. Venous port migration to the systemic circulation occurs in less than 1% of complications. The aim of this study is to describe a case of TIVAP migration to the hepatic vein. A 44-year-old female patient with breast cancer was prescribed neoadjuvant chemotherapy. A port-a-cath was surgically implanted for chemotherapy. During the port puncture procedure, blood returned normally when aspirated. When the port was first accessed and flushed with saline solution, swelling was observed at the port site and blood could no longer be aspirated. A chest radiography showed catheter embolization in the region of the hepatic vein. The catheter was retrieved using a snare technique (without complications) and the patient was discharged the next day. The care team should be alert to possible TIIVAP malfunction.

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Resumo O cateter totalmente implantável (CTI) é utilizado na administração da quimioterapia. Em menos de 1% dos casos de complicação, pode ocorrer migração do CTI para quimioterapia para a circulação sistêmica. O objetivo deste estudo foi descrever um caso de migração do CTI para a veia hepática. Uma paciente do sexo feminino, de 44 anos de idade, teve diagnóstico de câncer de mama com indicação de quimioterapia neoadjuvante. Realizou-se a implantação de cateter port-a-cath. Durante o procedimento de punção do cateter, houve retorno normal de sangue, e foi realizada infusão de soro fisiológico. Em seguida, houve um aumento de volume no local do port e não retorno de sangue à aspiração. A radiografia de tórax mostrou embolização do cateter em topografia hepática. Retirou-se o cateter pela técnica do laço (sem complicações), e a paciente recebeu alta no dia seguinte. Possíveis alterações no funcionamento do CTI devem chamar atenção da equipe responsável.

Abstract A totally implantable venous access port (TIVAP) is used for chemotherapy administration. Venous port migration to the systemic circulation occurs in less than 1% of complications. The aim of this study is to describe a case of TIVAP migration to the hepatic vein. A 44-year-old female patient with breast cancer was prescribed neoadjuvant chemotherapy. A port-a-cath was surgically implanted for chemotherapy. During the port puncture procedure, blood returned normally when aspirated. When the port was first accessed and flushed with saline solution, swelling was observed at the port site and blood could no longer be aspirated. A chest radiography showed catheter embolization in the region of the hepatic vein. The catheter was retrieved using a snare technique (without complications) and the patient was discharged the next day. The care team should be alert to possible TIIVAP malfunction.

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The external shape of the liver is varied and determines specific vascular arrangements. This morphological relationship is important to establish hepatic segmentation in different species submitted to surgeries that aim to preserve a larger area of liver parenchyma. After observing 60 livers injected with Neoprene Latex and three plastic moulds obtained by corrosion, eight hepatic venous segments were identified, drained by six hepatic veins agrouped into segmental veins, which drained one sector (segments I, VI, VII and VIII) and intersegmental veins, which drained more than one sector (segments II/III and IV/V). They were described as follows: left intersegmental vein, formed by a segmental vein from the papillary process (segment I), two to three lateral left segmental veins that drained the segment II, and one to five left paramedian segmental veins that drained the segment III; sagittal intersegmental vein, formed by the confluence between segmental vein of the quadrate lobe (segment IV) and the medial right paramedian segmental vein, which derived from the segment V; lateral right paramedian vein drained the dorsocranial sector of the segment VI; the lateral right segmental vein, formed by one to four vessels that drained segment VII, and the segmental vein of the caudate process, which drained the segment VIII. Understanding the number and disposition of the hepatic veins in lobate livers is essential to reduce bleeding risks in surgeries. The nomenclature based on segmentation analogy of non-lobate liver could be less confusing and, therefore, be more useful in the surgical approaches of lobate livers.

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The left hepatic vein (LHV) anomalous drainage into the coronary sinus (CS) is an extremely rare congenital vascular abnormality. It is usually asymptomatic, but it has surgical implications if the patient undergoes cardiac, vascular or hepatic procedures. We report a case of a 90-year-old man who had an isolated LHV anomalous drainage diagnosed on a computed tomography performed to evaluate fatigue. The diagnosis of LHV drainage into the CS during preoperative evaluation can avoid intraoperative complications and may determine the preferred surgical approach.

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SUMMARY: The liver dimensional (3D) models, consists of eight segments including portal triad (portal vein, hepatic artery, and bile duct), are necessary because it is difficult to dissect a liver and its inner structures. But it is difficult to produce 3D models from high resolution and color sectioned-images. This study presents automatic and accurate methods for producing liver 3D models from the sectionedimages. Based on the sectioned-images and color-filled-images of the liver, a 3D model including both the portal triad and hepatic vein was made. Referring to the 3D model, 3D models of liver's eight segments including the segmental branches of the portal triad and hepatic vein were completed and saved as STL format. All STL files were combined and saved as Liver-3D in PDF format for the common user. By functional subdivision of liver, the Liver-3D was divided into left (segments II, III, and, IV) and right (segments V, VI, VII, and VIII) liver in bookmark window of the PDF file. In addition, in Liver-3D, the primary to tertiary segmental branches of the portal triad could be shown in different colors. Owing to the difficulty of 3D modeling of liver including eight segments and segmental branches of the portal triad and hepatic, we started this research to find automatic methods for producing 3D models. The methods for producing liver 3D models will assist in 2D selection and 3D modeling of other complicated structures.

RESUMEN: Los modelos hepáticos dimensionales (3D) consisten en ocho segmentos que incluyen la tríada portal (vena porta, arteria hepática y conducto biliar), y son necesarios ya que es difícil disecar un hígado y sus estructuras internas. Sin embargo, es difícil producir modelos 3D a partir de imágenes en alta resolución e imágenes seccionadas en color. Este estudio presenta métodos automáticos y precisos para producir modelos 3D de hígado a partir de las imágenes seccionadas. Sobre la base de las imágenes seccionadas y las imágenes del hígado llenas de color, se realizó un modelo 3D que incluía tanto la tríada portal como la vena hepática. En referencia al modelo 3D, se completaron modelos 3D de los ocho segmentos del hígado que incluían las ramas segmentarias de la tríada portal y la vena hepática y se guardaron como formato STL. Todos los archivos STL fueron combinados y guardados como Liver-3D en formato PDF para el usuario común. Por subdivisión funcional del hígado, el hígado-3D se dividió en hígado izquierdo (segmentos II, III y IV) y derecho (segmentos V, VI, VII y VIII) en la ventana de marcador del archivo PDF. Además, en Liver-3D, las ramas segmentarias primarias a terciarias de la tríada portal podrían mostrarse en diferentes colores. Debido a la dificultad del modelado 3D del hígado, incluidos ocho segmentos y ramas segmentarias de la tríada portal y hepática, comenzamos esta investigación para encontrar métodos automáticos para producir modelos 3D. Los métodos para producir modelos 3D de hígado ayudarán en la selección 2D y el modelado 3D de otras estructuras complicadas.

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PURPOSE: To measure the distance between the right and middle hepatic veins and portal vein branches, in human cirrhotic liver casts. Was this measure actually smaller in the cirrhotic liver than in normal one? MATERIALS AND METHODS: This study was authorized by an area Research Ethics Committee, and each study subject or legal representative granted signed informed consent. Acrylic corrosion casts of 21 resected cirrhotic livers were generated. Diameters of hepatic veins and portal branches and pertinent intervening distances were measured. To assess differences in estimated average (relative to reference values), Student's t test for one sample was applied. RESULTS: Mean distances from right hepatic vein to the right portal branch and to portal vein bifurcation were 33 ± 6.4 and 36 ± 7.4 mm, respectively, both significantly less than published reference values in healthy human livers (p < 0.0001 and p < 0.0002, respectively). Mean distances from middle hepatic vein to right and left branches of portal vein were 36 ± 6.8 and 26 ± 8.8 mm, respectively. CONCLUSION: Distances separating right hepatic vein and portal vein (right branch and bifurcation) are diminished in cirrhotic livers compared to healthy ones. Given its caliber and proximity to portal branches, the middle hepatic vein remains as a reasonable alternative for TIPS procedures.

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The aim of this study was to assess the reproducibility of the ultrasound (US) measurement of craniocaudal displacement of the left branch of the portal vein as an indirect method of measuring right hemidiaphragm mobility in healthy young adults. Forty-one healthy participants were selected, ranging from 20 to 30 years of age. The US tests were conducted and interpreted by two observers (A and B) on two separate occasions (Test 1 and Test 2). Intra-observer and interobserver reproducibility and repeatability of US measurements were determined by the intraclass correlation coefficient (ICC[2,1] ) using a 95% confidence interval (CI). Interobserver reproducibility assessment showed 'high correlation' for Test 1 and Test 2 (ICC[2,1]  = 0·83, 95% CI = 0·70-0·91, and ICC[2,1]  = 0·79, 95% CI = 0·61-0·89, respectively). Intra-observer reproducibility assessment showed 'moderate correlation' for observer A (ICC[2,1]  = 0·69, 95% CI = 0·45-0·84) and for observer B (ICC[2,1]  = 0·65, 95% CI = 0·39-0·81). Repeatability assessment showed 'high correlation' for all tests performed (ICC[2,1]  = 0·86, 0·80, 0·74, 0·79, P<0·001). In conclusion, US measurement of craniocaudal displacement of the left branch of the portal vein is a reproducible method of measuring right hemidiaphragm mobility in healthy young adults.

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Juxtahepatic veins, retrohepatic vena cava or major hepatic veins injuries carry a very high mortality rate regardless the technique used for its repair. Isolated survivor reports have for the most part been managed by vascular isolation techniques, usually with atriocaval shunt. We report one case with a unique management technique in a patient who sustained gunshot wound to the retrohepatic vena cava. Hemorrhage control had been obtained by intrahepatic balloon tamponade after others maneuvers have failed. The balloon was left in situ for two days as damaged control laparotomy principles and planned reoperation has been chosen.

RESUMO

INTRODUÇÃO: No método piggyback de transplante de fígado (Tx), o pinçamento da veia cava inferior (VCI) do receptor é apenas parcial, permitindo a manutenção do retorno venoso durante a fase anepática sem a necessidade de utilização de desvio veno-venoso. A essa vantagem, contrapõe-se uma maior incidência de obstrução da drenagem venosa do enxerto, complicação que está relacionada com o tipo de reconstrução empregado. A implantação da VCI do enxerto no óstio das veias hepáticas média e esquerda (ME) do receptor tem sido evitada devido a uma maior freqüência de bloqueio venoso. Essa incidência diminui quando são empregadas a anastomose látero-lateral (LL) ou a implantação da VCI do enxerto no óstio das veias hepáticas direita, média e esquerda (DME) do receptor. Entretanto, essas reconstruções reduzem a eficiência do retorno venoso na fase anepática do Tx devido à constrição mais pronunciada da VCI durante o pinçamento necessário para a confecção da anastomose. A alternativa de utilizar o óstio formado pelas veias hepáticas direita e média (DM) pode propiciar uma constrição menor da VCI. Entretanto, esse benefício só se justifica se a via de efluxo venoso obtida não apresentar restrições anatômicas. O objetivo deste trabalho é comparar a congruência do perímetro da VCI com o perímetro das bocas anastomóticas e dos óstios de drenagem na VCI, obtidos por meio da utilização das modalidades DM e DME para a reconstrução do efluxo venoso no Tx piggyback. MÉTODO: Foram estudados prospectivamente 16 cadáveres frescos. Após a hepatectomia total, realizou-se o estudo morfométrico da confluência hepatocaval aferindo-se o perímetro da VCI (PVCI) e, nas reconstruções DM e DME, o perímetro das bocas anastomóticas (PDM e PDME) e dos óstios de desembocadura na VCI (PoDM e PoDME). Foram obtidas imagens digitalizadas de todos os perímetros. As medidas foram realizadas por meio do programa analisador de imagens KS300. A análise estatística foi realizada por meio de análise...

INTRODUCTION: In piggyback liver transplantation (LT), partial clamping of the recipient inferior vena cava (IVC) preserves the venous return of the lower extremities during the anhepatic phase precluding the use of venovenous bypass. The incidence of hepatic venous outflow obstruction after piggyback LT varies according to the type of venous reconstruction. Anastomosis between the cranial portion of the graft IVC and common stump of the middle and left hepatic veins (ME) of the recipient has been avoided due to a higher frequency of hepatic venous outflow obstruction. This incidence decreases when a cavo-caval side-to-side anastomosis (SS) or the ostium of the three main hepatic veins of the recipient (RML) are used. On the other hand, venous return is reduced in these modalities due to a more pronounced constriction during the IVC clamping. The use of the ostium formed by the right and middle hepatic veins (RM) may limit IVC constriction. However, this benefit is only justified if a hepatic venous outflow tract with no anatomical restrictions can be obtained. The aim of this study is to compare the congruence of the IVC perimeter with the perimeter of the venous outflow tract at the anastomotic site and also its opening into the IVC both in the RM and RML modalities. METHODS: Sixteen fresh human cadavers were prospectively studied. After total hepatectomy, a morphometric study of the hepatocaval confluence was done by measuring the perimeter of the IVC (IVCP) and, in RM and RML reconstructions, the perimeter of the venous outflow tract at the anastomotic site (RMP and RMLP) and at its opening into the IVC (RMoP and RMLoP). Digital images of all perimeters were obtained. The measurements were accomplished utilizing the KS300 image analysis software. The statistical analysis was performed using analysis of variance (ANOVA) for repeated measures. Statistical significance was established when the p value was less than 0.05. RESULTS: Examinations were...

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Objetivo: Identificar as veias e vasos portais hepáticos de cães por meio da ultrassonografia, avaliando a possibilidade de determinar seus lobos hepáticos com base naqueles vasos, de maneira semelhante à segmentação de fígados humanos. O exame ultrassonográfico é um bom método para a avaliação do fígado, fornecendo dados sobre seu tamanho, forma e alterações do parênquima. Em cães, embora a visibilizarão e diferenciação entre as veias hepáticas e os vasos portais seja possível, são de difícil identificação anatômica e não há descrição na literatura de nenhum método que permita determinar os lobos hepáticos. Material e Método: Foram selecionados 15 cães vivos para a realização de exames ultrassonográficos, sendo 10 hígidos e 5 com congestão venosa direita. Um cadáver foi utilizado para obtenção de molde vascular em vinil. Resultados e Conclusões: Os resultados foram registrados em vídeos e fotos, e mostraram que muitas das veias hepáticas e vasos do sistema porta hepático são de difícil identificação, o que permite concluir que o modelo humano de segmentação é inadequado para utilização em cães. Ainda assim, quando tal fenômeno é identificado, pode auxiliar na determinação dos lobos, pois representa importantes estruturas anatômicas de referência.(AU)

Objective: To identify the canine hepatic veins and portal hepatic vessels by ultrasonography, evaluating the possibility of hepatic lobe determination based on these vessels in dogs, similar lo human fiver segmentation. Ultrasonography is a good method for evaluation of the liver, giving information on size, shape and parenchymal changes. Although the visualization and differentiation between hepatic veins and portal vessels is possible in dogs, their anatomical identification is difficult and the literature does not describe any methods for hepatic lobe determination. Material and Method: Ultrasound scans were done in 15 five animals - 10 healthy dogs and 5 dogs presenting with right venous congestion. A cadaver was employed for obtainance of a vinyl vascular caste Results and Conclusions: Our results were documented by means of videos and photographs and showed that many of the hepatic veins and vessels of the porto hepatic system are difficult to identify, leading to the conclusion that the human model of segmentation is not adequate for use in dogs. Still, whenever identified these vessels can serve as an aid in lobe determination, once they are important reference anatomical structures(AU)

Objetivo: Identificar las venas y vasos portales hepáticos de perros a través de ultrasonografía, evaluándoselaposibilidad de determinar los lóbulos hepáticos de perros con base en esos vasos de manerasemejante a lasegmentación de hígados humanos. El examenultrasonográfico es un buen método para laevaluacióndelhígadoproveyendo dados sobre el tamaño, forma y alteraciones deli parénquima. En perros, aunque lavisualización y diferenciación entre las venas hepáticas y vasos portalesseaposible. son de difícil identificación anatómica y no haydescripción en la literatura de ningún método que permita determinar los lóbulos hepáticos. Material y Método: Se utilizaron 15 perros vivos para larealización de exámenesultrasonográficos, 10 sanas y 5 COII congestión venosa derecha. Se utilizó un cadáver para laobtencióndel molde vascular en vinilo. Resultados y Conclusiones: Los resultados se registraron en videos y fotos y mostraron que muchas de las venas hepáticas y vasos dei sistema porta hepático, son de difícil identificación, lo que permite concluir que el modelo humano de segmentación es inadecuado para la utilización en perros. A pesar de ello, siempre que los vasos sean identificados pueden ser utilizados como auxilio para determinación de los lóbulos, pues representan importantes estructuras anatómicas de referencia(AU)

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Objetivo: Identificar as veias e vasos portais hepáticos de cães por meio da ultrassonografia, avaliando a possibilidade de determinar seus lobos hepáticos com base naqueles vasos, de maneira semelhante à segmentação de fígados humanos. O exame ultrassonográfico é um bom método para a avaliação do fígado, fornecendo dados sobre seu tamanho, forma e alterações do parênquima. Em cães, embora a visibilizarão e diferenciação entre as veias hepáticas e os vasos portais seja possível, são de difícil identificação anatômica e não há descrição na literatura de nenhum método que permita determinar os lobos hepáticos. Material e Método: Foram selecionados 15 cães vivos para a realização de exames ultrassonográficos, sendo 10 hígidos e 5 com congestão venosa direita. Um cadáver foi utilizado para obtenção de molde vascular em vinil. Resultados e Conclusões: Os resultados foram registrados em vídeos e fotos, e mostraram que muitas das veias hepáticas e vasos do sistema porta hepático são de difícil identificação, o que permite concluir que o modelo humano de segmentação é inadequado para utilização em cães. Ainda assim, quando tal fenômeno é identificado, pode auxiliar na determinação dos lobos, pois representa importantes estruturas anatômicas de referência.

Objective: To identify the canine hepatic veins and portal hepatic vessels by ultrasonography, evaluating the possibility of hepatic lobe determination based on these vessels in dogs, similar lo human fiver segmentation. Ultrasonography is a good method for evaluation of the liver, giving information on size, shape and parenchymal changes. Although the visualization and differentiation between hepatic veins and portal vessels is possible in dogs, their anatomical identification is difficult and the literature does not describe any methods for hepatic lobe determination. Material and Method: Ultrasound scans were done in 15 five animals - 10 healthy dogs and 5 dogs presenting with right venous congestion. A cadaver was employed for obtainance of a vinyl vascular caste Results and Conclusions: Our results were documented by means of videos and photographs and showed that many of the hepatic veins and vessels of the porto hepatic system are difficult to identify, leading to the conclusion that the human model of segmentation is not adequate for use in dogs. Still, whenever identified these vessels can serve as an aid in lobe determination, once they are important reference anatomical structures

Objetivo: Identificar las venas y vasos portales hepáticos de perros a través de ultrasonografía, evaluándoselaposibilidad de determinar los lóbulos hepáticos de perros con base en esos vasos de manerasemejante a lasegmentación de hígados humanos. El examenultrasonográfico es un buen método para laevaluacióndelhígadoproveyendo dados sobre el tamaño, forma y alteraciones deli parénquima. En perros, aunque lavisualización y diferenciación entre las venas hepáticas y vasos portalesseaposible. son de difícil identificación anatómica y no haydescripción en la literatura de ningún método que permita determinar los lóbulos hepáticos. Material y Método: Se utilizaron 15 perros vivos para larealización de exámenesultrasonográficos, 10 sanas y 5 COII congestión venosa derecha. Se utilizó un cadáver para laobtencióndel molde vascular en vinilo. Resultados y Conclusiones: Los resultados se registraron en videos y fotos y mostraron que muchas de las venas hepáticas y vasos dei sistema porta hepático, son de difícil identificación, lo que permite concluir que el modelo humano de segmentación es inadecuado para la utilización en perros. A pesar de ello, siempre que los vasos sean identificados pueden ser utilizados como auxilio para determinación de los lóbulos, pues representan importantes estructuras anatómicas de referencia

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OBJETIVO: Aferir a independência da segmentação da drenagem venosa hepática, bem como a relação entre seus segmentos. MÉTODO: Foram utilizados trinta fígados humanos, analisados cuidadosamente para exclusão de possíveis rompimentos extra e intra-parenquimatosos. Foi injetada uma resina sintética (Resapol T-208) nas veias hepáticas direita, média e esquerda isoladamente, com diferentes cores, para identificação dos segmentos, utilizando-se a técnica de injeção-corrosão. Após a obtenção dos moldes, foi realizada a pesagem e a planimetria destes, em conjunto e separadamente. RESULTADOS: Foi observado que todos os moldes hepáticos apresentaram independência entre seus segmentos e que o segmento direito foi o maior (p=0,005). Ao correlacionar o peso do fígado com a proporção entre os segmentos, obteve-se um coeficiente de correlação de 0,023. CONCLUSÕES: Os segmentos das veias hepáticas são independentes entre si, ocorrendo preponderância do segmento venoso direito sobre os demais e o aumento do peso do fígado sem patologia corresponde a um aumento proporcional entre os seus segmentos.

OBJECTIVE: To establish the independence of segmentation of the hepatic venous drainage and the relationship among its segments. METHODS: Thirty livers were carefully analyzed in order to exclude any intraparenchymatous injury. A synthetic resin (Resapol T-208) was injected into each one of the hepatic veins (right, middle and left), in different colors, to identify each segment, using the injection-corrosion technique. In each liver the obtained casts were weighed and submitted to planimetry, separately and altogether. RESULTS: The fact that all the livers' casts have independent segments was noticed, and the right segment was the largest one (p=0,005). A coefficient of 0,023 was obtained correlating the weight of the liver with the proportion of its segments. CONCLUSIONS: Hepatic venous segments are independent and the right venous segment is predominant. Furthermore, the weight of a healthy liver is proportional to the size of its segments.

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Introduction: The commitment of the great blood-vessels make up a situation of great complexity and a high rate of the complications and mortality patients with abdominal trauma. The injury of the portal vein matters because of the difficulty on the diagnosis and the approach surgery. Objective: To set the standard on the transverse section of the pancreas looking for a safer surgical access to repair the portal vein injuries. Methods: A quantitative analysis was performed to characterize the anatomical relationship between the portal vein and their tributaries relating them to the pancreas. On these corpses, the measurements of a anatomical triangle were studied. It base was the upper limit of the superior mesenteric vein and the initial portion of the portal vein; the apex, a point located on the upper limit of the confluence of the splenic vein and superior mesenteric vein, situated at the middle line of the superior mesenteric_ vein. Results: The portal vein is formed 3.24cm from the internal border of the duodenal arc at a distance of 1.61cm and 1.07 from the inferior and superior pancreas borders, respectively. Conclusion: The present study allow us to conclude that, to have access to the origin of the portal vein, in case of trauma of this vessel, one should proceed a transverse section of the neck of the pancreas next to the superior mesenteric vein, because its confluence with splenic vein occur, on average, 1.07cm and 1.61cm from the superior and inferior border of the gland, respectively.

Introdução: No trauma abdominal, o comprometimento dos grandes vasos constitui uma situação de grande complexidade com altos índices de complicações e mortalidade. Nestes pacientes, a lesão da veia porta-hepática tem interesse em razão da dificuldade no diagnóstico e na abordagem cirúrgica. Objetivo: Padronizar o plano de transecção do pâncreas visando o acesso cirúrgico mais seguro para os reparos das lesões da veia porta-hepática. Métodos: Procedeu-se à uma análise quantitativa para caracterizar a relação anatômica da veia porta-hepática e suas tributárias relacionando-as com o pâncreas. Nestes cadáveres, estudou-se as medidas de um triângulo anatômico que tem como base o limite superior da veia mesentérica superior e porção inicial da veia porta; como ápice, um ponto localizado no limite superior da confluência das veias esplênica e mesentérica superior, situado na linha média da veia mesentérica superior. Resultados: A veia porta-hepática é formada a 3.24cm da borda interna do arco duodenal numa localização que dista 1.61cm e 1.07 das bordas inferior e superior do pâncreas, respectivamente. Conclusão: O presente estudo nos permite concluir que, para se fazer o acesso à origem da veia porta-hepática, em caso de trauma deste vaso, deve-se proceder a secção do colo do pâncreas junto à veia mesentérica superior, pois a confluência entre ela e a veia esplênica ocorre, em média, a 1.07cm da borda superior da glândula, e a 1.61cm de sua borda inferior.

RESUMO

The knowledge of the relationship of the inferior cava vein with the hepatic tissue is fundamental for it approach during the hepatic surgery. Contradictory data is observed in the literature. Objective: To study the relation, the number of confluent veins for the right contour and the distance of the retro-hepatic segment of inferior cava vein. Methods: The study was made on 38 human livers, between 13 and 98 years old of both sexes. Obtained the anatomical piece, the inferior cava vein was dissected, being observed it relation with the hepatic tissue. Inferior cava vein was measured. The retro-hepatic segment and the number of confluent veins for the right lateral contour of the inferior cava vein were measured. Statistic study was accomplished comparing the data in relation to the sex. Results: The lobe caudate and inferior cava vein relation was determined as incomplete in 37 (97,4%) cases. The total distance of the inferior cava vein in retro-hepatic segment was 59,66 mm. The number of confluent veins was of 3,44 larger significantily in the masculine sex (p = 0,027). Conclusions: The incomplete relation of the caudate lobe is found in most of the cases, this fact facilitates the surgical access the inferior cava vein when exposed by right contour. This vein presents a segment relatively short occupying a furrow in the subsequent part of the liver. A small number of veins converges for the right contour, larger significantly in male. The surgeon owes to worry with the dissection of the area due to presence of these vases and the possibility of bleeding.

O conhecimento da relação entre a veia cava inferior e o tecido hepático é fundamental para a sua abordagem durante a cirurgia hepática. Observa-se na literatura dados contraditórios. Objetivo: Pesquisar a sintopia da veia cava inferior, o número de veias confluentes para o contorno direito e a distância do segmento retro-hepático da veia cava inferior. Métodos: Foram estudados 38 fígados humanos, entre 13 e 98 anos de ambos sexos. Obtida a peça anatômica, era dissecada a veia cava inferior, observando-se a sua sintopia com o parênquima hepático. Foram obtidas medidas biométricas da veia cava inferior, como a medida do segmento retro-hepático e anotado o número de veias confluentes para o contorno lateral direito da veia cava inferior. Foi realizado estudo estatístico comparando os dados em relação ao sexo. Resultados: a sintopia do lobo caudado foi determinada como incompleta em 37 (97,4%) casos. A distância total da veia cava inferior em seu segmento retro-hepático foi em média 59,66 mm. O número de veias confluentes foi de 3,44 significantemente maior no sexo masculino (p = 0,027). Conclusões: A sintopia incompleta do lobo caudado é encontrada na maioria dos casos. Este fato facilita o acesso cirúrgico a veia cava inferior retro-hepática quando exposta pelo seu contorno lateral direito. Esta veia apresenta um segmento relativamente curto ocupando um sulco na parte posterior do fígado. Um pequeno número de veias confluem para o contorno direito, significantemente maior no sexo masculino. Deve o cirurgião preocupar-se com a dissecção da região devido a presença destes vasos e a possibilidade de sangramentos volumosos.

RESUMO

The hepatic portion of the caudal vena cava was studied in 100 livers of adult, male, Nelore bovines, from Aragatuba, SP. The hepatic portions varied from 12 to 27 cm in length (average 19.9 cm); the distance of this portion between the ostia of the right and intermediate hepatic veins ranged from 15 to 9 cm (average 5.3 cm); the diameter of the caudal vena cava at the level of the liver varied from 5 to 12.5 cm (average 8.8 cm); the ostia of smaller hepatic veins ranged from 12 to 35 (higher frequency: 17, in 13%).

O estudo a fresco em 100 fígados de bovinos, machos, adultos, da raça Nelore, oriundos de e abatidos em Araçatuba (SP), permitiunos observar que o trato da veia cava caudal, em correspondência ao órgão em questão, varia de 12 cm a 27cm, com uma média de 19,9 cm; a distância entre óstios das veias hepáticas direita e intermédia no trato varia de 1,5 cm a 9,0 cm, com 5,3 cm em média; o diâmetro do trato da veia cava caudal, em sua coincidência com o fígado, oscila entre 5 cm e 12,5 cm, alcançando 8,8 cm em média; os óstios das veias hepáticas menores são contados entre 12 e 35, com maior freqüência de 17 (13%).