Triantafyllou George, Belimezakis Nektarios, Lyros Orestis, Tsakotos George, Botis George, Piagkou Maria
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece.
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece.
Ann Anat. 2025 Jan;257:152343. doi: 10.1016/j.aanat.2024.152343. Epub 2024 Oct 5.
The current evidence-based systematic review with meta-analysis presents a detailed overview of the cystic artery (CA) surgical anatomy, including its origin, number, topography, and morphometry. Moreover, the surgical implications of these variants are further discussed.
According to the Evidence-Based Anatomy Workgroup and PRISMA 2020 guidelines, the systematic review was performed using four online databases. The Anatomical Quality Assurance Tool was used to evaluate the risk of bias. Meta-analysis was performed with the R programming software. The pooled prevalence and pooled mean of different CA parameters were calculated.
The CA most commonly originated from the right hepatic artery (a pooled prevalence of 85.75 %). Other described origins (in order of frequency) were the aberrant right hepatic artery, the common hepatic, the left hepatic, the gastroduodenal, the superior mesenteric, and the middle hepatic arteries. The CA was single in 88.59 %, while it can be identified as double, triple, or absent. Most commonly, it was located inside the cystohepatic triangle in 83.83 %. Most commonly, it was superomedially to the cystic duct (77.80 %) and posteriorly to the common hepatic duct (35.08 %). The CA pooled mean length was 21.34 mm, and its diameter was more commonly over 1 mm.
The CA surgical anatomy is paramount when operating on the gallbladder. The CA's altered anatomy and adjacent area could lead to confusion, iatrogenic injury, and prolonged surgical time. The CA depicts high morphological variability; therefore, surgeons should consider the typical anatomy and possible (usual and unusual) variants.
当前基于证据的系统评价及荟萃分析详细概述了胆囊动脉（CA）的手术解剖结构，包括其起源、数量、位置及形态测量。此外，还进一步讨论了这些变异的手术意义。
根据循证解剖学工作组和PRISMA 2020指南，使用四个在线数据库进行系统评价。采用解剖学质量保证工具评估偏倚风险。使用R编程软件进行荟萃分析。计算不同CA参数的合并患病率和合并均值。
CA最常见起源于肝右动脉（合并患病率为85.75%）。其他描述的起源（按频率排序）为迷走肝右动脉、肝总动脉、肝左动脉、胃十二指肠动脉、肠系膜上动脉和肝中动脉。CA单一存在的占88.59%，也可表现为双支、三支或缺如。最常见的是，83.83%位于胆囊肝三角内。最常见的是，77.80%位于胆囊管的上内侧，35.08%位于肝总管后方。CA的合并平均长度为21.34mm，其直径通常超过1mm。
在进行胆囊手术时，CA的手术解剖结构至关重要。CA解剖结构的改变及其邻近区域可能导致混淆、医源性损伤和手术时间延长。CA表现出高度的形态变异；因此，外科医生应考虑其典型解剖结构及可能的（常见和不常见）变异。
