胆囊管解剖变异的诊断及其临床意义

目的　探讨胆囊管的解剖变异的诊断及其在胆囊切除术中的意义。方法　回顾性分析我院连续 5 0 0例胆囊切除术时所发现的 5 2例胆囊管变异 ,对其病理类型和手术处理技巧进行讨论。结果　术前ERCP、MRCP所发现的胆囊管变异与手术证实的胆囊管变异有高度的一致性(Kappa值分别为 0 .815和 0 .868,P <0 .0 0 1)。胆囊管低位汇入肝总管下端者合并胆总管结石显著高于其他类型胆囊管变异者 (P <0 .0 0 1) ;术中医源性胆道损伤 4例 ,皆发生在有胆囊管变异的患者 ,其发生率显著高于无胆囊管变异的患者 ,全组无死亡病例。结论　术前酌情选用ERCP或MRCP ,可发现胆囊管变异 ,并有较高的准确性。术中探查及必要的术中胆道造影和胆道镜是发现和处理胆囊管变异的最好方法

Diagnosis of the anatomic variations of the cystic duct and its clinical significance

Objective To explore the diagnosis of the anatomic variations of the cystic duct and its clinical significance.Methods From the retrospective analysis of 500 cases of cholecystectomy in our hospital,52 cases with variations of the cystic duct were discovered,their pathological types and operation's techniques were discussed.Results There was a high uniformity between the variations of the cystic duct found by preoperative ERCP or MRCP and those proved by operation(Kappa value respectively for 0.815 and 0.868,P<0.001).The low abouchement of the cystic duct in the low extremity of the common hepatic duct combined to the choledochus stones has more significanct difference than other variations of the cystic duct(P<0.001),4 cases of the intraoperative iatrogenic injuries of the biliary tract,all were found in the patients who had anatomic variations of the cystic duct,theirs incidence was higher than other cases without cystic duct anomalies,no death in the entire of this group.Conclusion Performing ERCP or MRCP before the operation accordingly,is of much importance to find anatomic variations of the cystic duct,and it has a higher accuracy.The intraoperative exploration and necessary cholangiography or cholangioscopy are the best methods to discover the anatomic variations of the cystic duct.