Chikamori Fumio, Ueta Koji, Iwabu Jun, Sharma Niranjan
Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan.
Adv Train Gastroint & Organ Transp Surgery, Dunedin, New Zealand.
Radiol Case Rep. 2022 Apr 4;17(6):1843-1847. doi: 10.1016/j.radcr.2022.03.031. eCollection 2022 Jun.
Aberrant right posterior hepatic duct (ARPHD) is one of the anatomical anomalies of the bile duct. It is a risk factor for bile duct injury during laparoscopic cholecystectomy (LC). ARPHD can be diagnosed before surgery by magnetic resonance cholangiopancreatography or drip infusion cholangiographic-computed tomography. However, it is not easy to identify ARPHD during LC. Classic intraoperative cholangiography (IOC) procedure that does not lead to bile duct injury avoidance needs to be modified. In modified IOC, cannulation is performed from the infundibulum or neck of the gallbladder. We reported a modified and dynamic IOC procedure that can identify ARPHD safely and precisely during LC. The modified IOC provided direct evidence of no injury to ARPHD in 2 cases.
肝右后叶异常胆管（ARPHD）是胆管的解剖变异之一。它是腹腔镜胆囊切除术（LC）期间胆管损伤的一个危险因素。ARPHD可在手术前通过磁共振胰胆管造影或滴注式胆管造影计算机断层扫描进行诊断。然而，在LC期间识别ARPHD并不容易。不导致避免胆管损伤的经典术中胆管造影（IOC）程序需要改进。在改良的IOC中，插管是从胆囊漏斗部或颈部进行的。我们报告了一种改良的动态IOC程序，该程序可以在LC期间安全、准确地识别ARPHD。改良的IOC在2例病例中提供了未损伤ARPHD的直接证据。
