Fujiwara Kenji, Hiraka Kiyohisa, Shindo Koji, Abe Atsushi, Masatsugu Toshihiro, Hirano Tatsuya, Sada Masayuki
Department of Surgery, Sada Hospital, Fukuoka, Japan.
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Surg Radiol Anat. 2024 Feb;46(2):223-230. doi: 10.1007/s00276-023-03275-9. Epub 2024 Jan 10.
Evaluation of the cystic duct anatomy prior to bile duct or gallbladder surgery is important, to decrease the risk of bile duct injury. This study aimed to clarify the frequency of cystic duct variations and the relationship between them.
Data of 205 patients who underwent cholecystectomy after imaging at Sada Hospital, Japan, were analyzed. The Chi-square test was used to analyze the relationships among variations.
The lateral and posterior sides of the bile duct were the two most common insertion points (92 patients, 44.9%), and the middle height was the most common insertion height (135 patients, 65.9%). Clinically important variations (spiral courses, parallel courses, low insertions, and right hepatic duct draining) relating to the risk of bile duct injury were observed in 24 patients (11.7%). Regarding the relationship between the insertion sides and heights, we noticed that the posterior insertion frequently existed in low insertions (75.0%, P < 0.001) and did not exist in high insertions. In contrast, the anterior insertion coexisted with high and never low insertions. Spiral courses have two courses: anterior and posterior, and anterior ones were only found in high insertion cases.
The insertion point of the cystic duct and the spiral courses tended to be anterior or lateral superiorly and posterior inferiorly. Clinically significant variations in cystic duct insertions are common and surgeons should be cautious about these variations to avoid complications.
在胆管或胆囊手术前评估胆囊管解剖结构很重要，以降低胆管损伤风险。本研究旨在明确胆囊管变异的频率及其相互关系。
对日本萨达医院205例在影像学检查后接受胆囊切除术患者的数据进行分析。采用卡方检验分析变异之间的关系。
胆管的外侧和后侧是两个最常见的汇入点（92例患者，44.9%），中等高度是最常见的汇入高度（135例患者，65.9%）。在24例患者（11.7%）中观察到与胆管损伤风险相关的具有临床意义的变异（螺旋走行、平行走行、低位汇入和右肝管引流）。关于汇入侧与高度之间的关系，我们注意到低位汇入中后侧汇入较为常见（75.0%，P < 0.001），而高位汇入中不存在这种情况。相反，前侧汇入与高位汇入并存，且从不与低位汇入并存。螺旋走行有前后两种走行方式，且前侧走行仅在高位汇入病例中发现。
胆囊管的汇入点及螺旋走行倾向于在上方靠前或靠外侧，下方靠后。胆囊管汇入的具有临床意义的变异很常见，外科医生应对这些变异保持谨慎以避免并发症。
