Wang Zhen J, Yeh Benjamin M, Roberts John P, Breiman Richard S, Qayyum Aliya, Coakley Fergus V
Department of Radiology, University of California San Francisco, Box 0628, C-324C, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA.
Radiology. 2005 Jun;235(3):899-904. doi: 10.1148/radiol.2353040424. Epub 2005 Apr 15.
To retrospectively evaluate computed tomographic (CT) cholangiography in the depiction of second-order biliary tract anatomy in living donor candidates for right hepatic lobe transplantation.
Human research committee approval was obtained, informed consent was not required, and the study was compliant with the Health Insurance Portability and Accountability Act. The authors identified all living right-lobe liver donor candidates who underwent CT cholangiography at their institution between October 2001 (when CT cholangiography was introduced at the institution) and March 2003 (n = 62). There were 41 men (mean age, 36 years; range, 18-55 years) and 21 women (mean age, 40 years; range, 22-55 years). Two readers in consensus rated quality of second-order bile duct visualization at CT cholangiography on a four-point scale (0, not seen; 3, excellent visualization) and noted the presence of variant second-order biliary tract branching anatomy. CT cholangiography findings were compared with those at surgery in subjects who underwent right hepatic lobe retrieval (n = 24). In addition, adult donors who underwent right hepatic lobe retrieval between January 2000 and March 2003 (29 men, mean age, 35 years [range, 20-52 years]; 18 women, mean age, 38 years [range, 23-54 years]) were identified. Numbers of donors who underwent intraoperative cholangiography before and after the introduction of CT cholangiography were compared by using the Fisher exact test.
The mean second-order bile duct score at CT cholangiography was 2.9 (range, 2-3). Of 24 subjects who underwent right lobe retrieval, biliary tract anatomy determined at CT cholangiography was concordant with findings at surgery in 23 (96%). Variant second-order branching anatomy was seen in 13 subjects (54%) at surgery; one variant branch was missed at CT cholangiography. Of 47 subjects who underwent right hepatic lobe retrieval, significantly fewer subjects required conventional intraoperative cholangiography after the introduction of CT cholangiography (three of 24 subjects [12%]) than before (23 of 23 subjects; P < .0001).
CT cholangiography accurately depicts biliary tract anatomy in living donor candidates for right hepatic lobe transplantation, and donors who undergo preoperative CT cholangiography are unlikely to need conventional intraoperative cholangiography.
回顾性评估计算机断层扫描（CT）胆管造影在右肝叶移植活体供者候选者二级胆管解剖结构显示中的应用。
本研究获得了人类研究委员会的批准，无需知情同意，且符合《健康保险流通与责任法案》。作者确定了2001年10月（该机构引入CT胆管造影时）至2003年3月期间在其机构接受CT胆管造影的所有活体右肝叶供者候选者（n = 62）。其中男性41名（平均年龄36岁；范围18 - 55岁），女性21名（平均年龄40岁；范围22 - 55岁）。两名阅片者一致根据四点量表对CT胆管造影时二级胆管的显示质量进行评分（0分，未见；3分，显示极佳），并记录二级胆管分支解剖结构变异的情况。将接受右肝叶切除的受试者（n = 24）的CT胆管造影结果与手术结果进行比较。此外，确定了2000年1月至2003年3月期间接受右肝叶切除的成年供者（男性29名，平均年龄35岁[范围20 - 52岁]；女性18名，平均年龄38岁[范围23 - 54岁]）。采用Fisher精确检验比较CT胆管造影引入前后接受术中胆管造影的供者数量。
CT胆管造影时二级胆管的平均评分为2.9（范围2 - 3）。在接受右肝叶切除的24名受试者中，CT胆管造影确定的胆管解剖结构与手术结果在23名受试者（96%）中一致。手术中13名受试者（54%）可见二级分支解剖结构变异；CT胆管造影时遗漏了1个变异分支。在47名接受右肝叶切除的受试者中，与CT胆管造影引入前相比，引入后需要进行传统术中胆管造影的受试者显著减少（24名受试者中有3名[12%]）（23名受试者中有23名；P <.0001）。
CT胆管造影能准确显示右肝叶移植活体供者候选者的胆管解剖结构，且接受术前CT胆管造影的供者不太可能需要传统的术中胆管造影。
