Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan.
Department of Pediatric Surgery and Transplantation, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Asian J Endosc Surg. 2023 Jul;16(3):546-549. doi: 10.1111/ases.13175. Epub 2023 Mar 21.
Although laparoscopic cholecystectomy is a well-established surgical procedure, an accessory hepatic duct (AcHD) entering the cystic duct is poorly understood. A 77-year-old woman with symptomatic cholecystlithiasis was referred to our hospital. Abdominal ultrasonography indicated several small stones in the gall bladder. Magnetic resonance cholangiopancreatography (MRCP) did not reveal an anomalous cystic duct. Dissecting the gall bladder bed at operation, AcHD entering the cystic duct was suspected. Intraoperative cholangiography revealed that B5 branch entered the cystic duct. We ligated the AcHD, and divided it. Laparoscopic cholecystectomy was completed, and the patient was discharged without any complication. A week after the operation, MRCP showed that ventral branch of B5 was dilated. The patient showed no symptom for more than a year. The present case exhibited extremely rare AcHD entering the cystic duct, which was hardly recognized before surgery. It is possible to recognize such anomalous variants with standard laparoscopic approach based on 2018 Tokyo Guidelines and with attention to the possibilities of AcHD entering the cystic duct.
尽管腹腔镜胆囊切除术是一种成熟的手术方法，但对于进入胆囊管的副肝管（AcHD）了解甚少。一位 77 岁的女性因有症状的胆囊结石被转诊至我院。腹部超声检查显示胆囊内有几个小结石。磁共振胰胆管成像（MRCP）未显示异常的胆囊管。手术中在胆囊床解剖时，怀疑有进入胆囊管的副肝管。术中胆管造影显示 B5 分支进入胆囊管。我们结扎并切断了 AcHD。完成了腹腔镜胆囊切除术，患者无任何并发症出院。术后一周，MRCP 显示 B5 的腹侧分支扩张。患者一年多来没有任何症状。本例表现为极其罕见的进入胆囊管的副肝管，术前几乎无法识别。根据 2018 年东京指南，采用标准腹腔镜方法并注意到进入胆囊管的副肝管的可能性，有可能识别出这种异常变异。
