胆囊管解剖变异的MRCP诊断

目的:探讨磁共振胰胆管成像(MRCP)对胆囊管解剖变异的诊断价值及临床意义.方法:搜集2002年8月～2006年8月期间行MRCP检查的900例病例进行分析,对显示不清的胆囊管视为正常.所有病例经胆囊切除术(783例)或逆行胰胆管造影术(117例)证实.结果:MRCP清晰显示胆囊管801例(89%),根据Taoureal胆囊管解剖变异分型标准:胆囊管变异53例,变异率为5.9%,其中胆囊管汇入左右肝管分叉处21例(2.3%),汇入右肝管10例(1.1%),与肝总管并行9例(1.0%),胆囊管低位插入8例(0.9%),旋前插入肝总管7例(0.8%),旋后插入肝总管3例(0.3%),过短1例(0.1%),囊状扩张1例(0.1%),合并胆囊分隔6例(0.7%),先天性胆总管囊肿6例(0.7%).部分患者合并2种或2种以上的变异.其中假阴性2例,显示不清2例.结论:MRCP能显示各种胆囊管解剖变异,术前了解这些变异有助于减少腹腔镜胆囊切除术中的胆道损伤.

Anatomic Variants of the Cystic Duct:Diagnosis with MR Cholangio-pancreatography

Objective:To study the clinical significance,advantage and drawback of MR cholangio-pancreatography (MRCP) in diagnosing the anatomic variants of the cystic duct.Methods:MRCP was performed in 1036 patients ranged from 2002-8~2006-8,which were evaluated by two senior radiologists independently,if there was any discrepancy,consultation was needed to make the final diagnosis.The imaging materials were retrospectively analyzed.All of the MRCP were proved by cholecystectomy (783 patients) and endoscopic retrograde pancreatico-cholangiography (ERCP) (117 patients).Results:Cystic ducts were clearly assessed in 801 patients (89%) by MRCP,anatomic variants of cystic duct were demonstrated in 53 cases (5.9%).According to the Taoureal classification of cystic duct anatomic variants,there was convergence of cystic duct into the bifurcation of left and right hepatic duct (21 cases,2.3%),convergence into right hepatic (10 cases,1.1%),parallel with common hepatic duct (9 cases,1.0%),low cystic duct (8 cases,0.9%),pronated forward and converged into common hepatic duct (7 cases,0.8%),pronated backward and converged into common hepatic duct (3 cases,0.3%),shortage of cystic duct (1 case,0.1%),cholangioectasis (1 case,0.1%),combined with gall bladder septation (6 cases,0.7%),congenital choledochocele (6 cases,0.7%).Some of these patients had two or more anatomic variants.Altogether there were false negative and unsatisfactory MRCP (n=2 of each).Conclusion:Various kinds of anatomic variant of cystic duct could be displayed by MRCP,biliary duct injuries could be avoided by understanding these variants before laparoscopic cholecystectomy.