Deka Pranjal, Islam Mahibul, Jindal Deepti, Kumar Niteen, Arora Ankur, Negi Sanjay Singh
Department of HPB Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
Indian J Gastroenterol. 2014 Jan;33(1):23-30. doi: 10.1007/s12664-013-0371-9. Epub 2013 Sep 5.
Variations in biliary anatomy are common, and different classifications have been described. These classification systems have not been compared to each other in a single cohort. We report such variations in biliary anatomy on magnetic resonance cholangiopancreatography (MRCP) using six different classification systems.
In 299 patients undergoing MRCP for various indications, biliary anatomy was classified as described by Couinaud (1957), Huang (1996), Karakas (2008), Choi (2003), Champetier (1994), and Ohkubo (2004). Correlation with direct cholangiography and vascular anatomy was done. Bile duct dimensions were measured. Cystic duct junction and pancreaticobiliary ductal junction (PBDJ) were classified.
Normal biliary anatomy was noted in 57.8 %. The most common variants were Couinaud type D2, Choi type 3A, Huang type A1, Champetier type a, Ohkubo types D and J, and Karakas type 2a. The Ohkubo classification was the most appropriate; 3.1 % of right ducts and 6.3 % of left ducts with variant anatomy could not be classified using the Ohkubo classification. There was a good agreement between MRCP and direct cholangiography (ĸ = 0.9). Anomalous PBDJ was noted in 8.7 %. Variant biliary anatomy was not associated with gender (p = 0.194) or variant vascular anatomy (p = 0.24).
Although each classification system has its merits and demerits, some anatomical variations cannot be classified using any of the previously described classifications. The Ohkubo classification system is the most applicable as it considers most clinically relevant variations pertinent to hepatobiliary surgery.
胆道解剖变异很常见，并且已经有不同的分类方法被描述。这些分类系统尚未在单一队列中相互比较。我们使用六种不同的分类系统报告磁共振胰胆管造影（MRCP）上的胆道解剖变异情况。
对299例因各种适应证接受MRCP检查的患者，按照Couinaud（1957年）、Huang（1996年）、Karakas（2008年）、Choi（2003年）、Champetier（1994年）和Ohkubo（2004年）所描述的方法对胆道解剖进行分类。与直接胆管造影和血管解剖进行相关性分析。测量胆管尺寸。对胆囊管汇合处和胰胆管汇合处（PBDJ）进行分类。
57.8%的患者胆道解剖正常。最常见的变异类型为Couinaud D2型、Choi 3A 型、Huang A1型、Champetier a型、Ohkubo D型和J型以及Karakas 2a型。Ohkubo分类最为合适；使用Ohkubo分类无法对3.1%的右侧胆管和6.3%的左侧胆管解剖变异进行分类。MRCP与直接胆管造影之间具有良好的一致性（ĸ = 0.9）。8.7%的患者存在异常PBDJ。胆道解剖变异与性别（p = 0.194）或血管解剖变异（p = 0.24）无关。
尽管每种分类系统都有其优缺点，但有些解剖变异无法用任何先前描述的分类进行分类。Ohkubo分类系统最为适用，因为它考虑了与肝胆外科手术相关的大多数临床相关变异。
