Kitami Masahiro, Takase Kei, Murakami Gen, Ko Saiho, Tsuboi Masahiro, Saito Haruo, Higano Shuichi, Nakajima Yoshiyuki, Takahashi Shoki
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
Radiology. 2006 Jan;238(1):156-66. doi: 10.1148/radiol.2381041783.
To retrospectively determine whether major portal venous variation was more frequently associated with biliary variants, with consideration of the types and frequencies of biliary tract variations in the right and left liver lobes.
Before undergoing computed tomographic (CT) cholangiography, patients gave informed consent. The retrospective research protocol was approved, and informed consent was waived by the ethics committee. Forty-four patients aged 29-80 years who underwent multi-detector row CT cholangiography had a major portal vein variation in which the main portal vein diverged into the common trunk of the left portal vein and right anterior sectorial portal vein. One hundred fifty-eight consecutive patients aged 26-89 years who did not have this variation served as the control group. Three radiologists retrospectively evaluated the confluence pattern of the bile duct, the relationship between this pattern and the portal vein, and the major branching pattern of the portal vein. Pearson chi2 and Fisher exact tests were performed to identify significant differences between the two patient groups.
The classic hilar confluence pattern, where the right posterior sectorial duct connects supraportally with the right anterior sectorial duct, was less frequent in the patients with the portal vein variation than in the control subjects (32% vs 73%, P < .05). The following biliary tract variations were identified more frequently in the variation group than in the control group (P < .05): right posterior sectorial duct joining left hepatic duct with a supraportal course (34% vs 12%), right posterior sectorial duct joining right anterior sectorial duct with an infraportal course (13% vs 4%), right posterior sectorial duct following an infraportal course (23% vs 8%), and left lateral segmental ducts caudal to the umbilical portion of the portal vein (14% vs 3%). The right hepatic duct, which receives all biliary ducts from the right lobe, was significantly less frequently developed in the variation group (46% vs 79%, P < .05). In addition, retroportal bile ducts were seen in four patients with the portal vein variation (P < .05).
Bile duct configurations in patients with portal vein variation were significantly different from those in control subjects.
回顾性确定主要门静脉变异是否更常与胆管变异相关，并考虑左右肝叶胆管变异的类型和频率。
在接受计算机断层扫描（CT）胆管造影之前，患者签署知情同意书。回顾性研究方案已获批准，伦理委员会免除了知情同意。44例年龄在29 - 80岁之间接受多排探测器CT胆管造影的患者存在主要门静脉变异，即门静脉主干分为左门静脉和右前叶门静脉的共同主干。158例年龄在26 - 89岁之间无此变异的连续患者作为对照组。三名放射科医生回顾性评估胆管的汇合模式、该模式与门静脉的关系以及门静脉的主要分支模式。采用Pearson卡方检验和Fisher精确检验来确定两组患者之间的显著差异。
门静脉变异患者中，右后叶胆管与右前叶胆管在肝门上方汇合的经典肝门汇合模式比对照组少见（32%对73%，P <.05）。变异组中以下胆管变异比对照组更常见（P <.05）：右后叶胆管经肝门上方路径汇入左肝管（34%对12%）、右后叶胆管经肝门下方路径汇入右前叶胆管（13%对4%）、右后叶胆管走行于肝门下方路径（23%对8%）以及左外侧段胆管位于门静脉脐部下方（14%对3%）。变异组中接受来自右叶所有胆管的右肝管发育明显较少见（46%对79%，P <.05）。此外，在4例门静脉变异患者中可见门静脉后胆管（P <.05）。
门静脉变异患者的胆管形态与对照组有显著差异。
