Naeem Muhammad Qasim, Ahmed Muhammad Saad, Hamid Kamran, Shazlee Muhammad Kashif, Qureshi Farheen, Asad Ullah Muhammad
Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK.
Cureus. 2020 Dec 27;12(12):e12329. doi: 10.7759/cureus.12329.
Introduction Hepatobiliary tree variant anatomy is crucial to understand the preoperative planning of hepatobiliary surgeries. Although the presence of variant anatomy is not an absolute contraindication for liver transplantation, inadvertent mapping can lead to postoperative biliary complications. These variants are also important to be recognized in various hepatobiliary surgeries and interventional procedures. Magnetic resonance cholangiopancreatography (MRCP) is an excellent non-invasive imaging tool that can identify biliary anatomy. The purpose of the current study is focused on determining anatomical variants of the biliary tree on MRCP in our population visiting a teaching hospital in Karachi. Methods This cross-sectional study was conducted on patients referred to Dr. Ziauddin Hospital for MRCP. MRCP was performed on MAGNETOM Avanto, SIEMENS, Belgium, Germany. Images were analyzed on a workstation by two radiologists and a postgraduate trainee. A senior radiologist reviewed equivocal cases. SPSS 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi-square test was used to see the link between anatomical variants of biliary tree and gender. P-value of ≤0.05 was considered as statistically significant. Results We recruited 369 patients undergoing MRCP consecutively for our study. Out of 369, 342 patients were eligible for analysis (139 males and 203 females). Standard anatomy was found to be prevalent in 65.8%. Type 3 was the leading variant. A statistically significant difference was recorded for the type 2 anatomic variant which was more frequent in males than females (p-value <0.001), while types 1, 3, and 4 anatomic variants were found to be more in females than males but this difference was not statistically significant. Few other variants were also recorded. Conclusion This study is robust evidence regarding biliary variants in Pakistan. It is important to consider these variants in our region, owing to an increased trend of liver transplants and other hepatobiliary procedures.
引言 肝胆管树的变异解剖对于理解肝胆手术的术前规划至关重要。虽然变异解剖结构的存在并非肝移植的绝对禁忌证，但术中意外识别可能导致术后胆道并发症。在各种肝胆手术和介入操作中，识别这些变异也很重要。磁共振胰胆管造影（MRCP）是一种出色的非侵入性成像工具，可识别胆道解剖结构。本研究的目的是确定在卡拉奇一家教学医院就诊的人群中，MRCP上胆管树的解剖变异情况。
方法 本横断面研究对转诊至齐亚乌丁医院进行MRCP检查的患者进行。MRCP检查在比利时和德国西门子公司的MAGNETOM Avanto磁共振成像仪上进行。由两名放射科医生和一名研究生实习生在工作站上分析图像。一名资深放射科医生复查有疑问的病例。使用SPSS 22.0（SPSS公司，伊利诺伊州芝加哥）进行统计分析。采用卡方检验观察胆管树解剖变异与性别的关系。P值≤0.05被认为具有统计学意义。
结果 我们连续招募了369例接受MRCP检查的患者进行研究。在这369例患者中，342例患者符合分析条件（139例男性和203例女性）。标准解剖结构占65.8%。3型是主要变异类型。2型解剖变异在男性中比女性更常见，差异有统计学意义（P值<0.001），而1型、3型和4型解剖变异在女性中比男性更多，但差异无统计学意义。还记录了其他一些变异类型。
结论 本研究为巴基斯坦的胆道变异提供了有力证据。鉴于肝移植和其他肝胆手术趋势增加，在我们地区考虑这些变异很重要
