少见胆囊管变异一例分析  

A rare case of anatomical variations of cystic duct

作　　者：胥楠[1] 蒋力生[2] 严律南[1] 杨家印[1] 王文涛[1] 徐明清[1] 

机构地区：[1]四川大学华西医院肝脏血管外科,成都610041 [2]四川大学华西医院胆道外科,成都610041

出　　处：《中华肝胆外科杂志》2010年第9期675-677,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨胆囊管变异对胆囊切除术前诊断及手术方案的影响.方法 回顾性分析四川大学华西医院肝脏血管外科近期收治的1例胆囊管变异病人的术前诊断及术中术后处理临床资料.结果 该例术前MRCP显示胆总管梭形扩张,怀疑胆总管内隔膜形成.经ERCP检查发现胆囊管细长,经肝总管后方在肝总管左侧与其并行低位汇合从而构成MRCP上胆总管异常改变.明确诊断后为避免胆道损伤采用开腹胆囊切除术.结论 胆囊管汇人位置、走形方向及形态变异较多,术前对于诊断有疑问的胆囊结石或非结石性胆囊炎病人联合应用MRCP及ERCP能显著提高胆囊管变异的诊断正确率.为避免胆道损伤,对于胆囊管变异者开腹胆囊切除优于腹腔镜胆囊切除术.Objective To discuss the influence of anatomical variations of the cystic duct on preoperative diagnosis and operational scheme for cholecystectomy. Methods A 47-year-old woman was admitted to our hospital with diagnosis of cholecystolithiasis. Ultrasonography suggested minimal intra- and extrahepatic ductal dilatation. Laboratory tests showed that serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were 189 IU/L, 366 IU/L and 144 IU/L, respectively. In order to make a certain diagnosis, the patient received both magnetic resonance cholangiopancreatography （MRCP） and endoscopic retrograde cholangiopancreatography （ERCP）. Results MRCP showed the bile duct slightly dilated with a shuttle shape figure and a lower signal with a strip form in it. MRCP could not confirm the quality of this signal and was doubtful of choledochus diaphragma. Subsequently, ERCP was applied to demonstrate that the cystic duct was collateral with the common hepatic duct when arriving into its left side and converged into the bile duct with a lower position, which was the reason for why MRCP misjudged the formation of choledochus diaphragma in the bile duct. Finally, the patient underwent open cholecystectomy. Conclusion There are some kinds of variations in the cystic duct including course, appearance and location of confluence. Combing MRCP with ERCP can significantly elevate the diagnostic accuracy of the cystic duct before operation, especially in those patients with doubtful diagnosis upon admission. To avoid biliary injury as much as possible, open cholecystectomy is superior to the laparoscopic cholecystectomy （LC）with regard to the patients suffering from cholecystolithiasis complicated with variation of the cystic duct.

关 键 词：胆囊管 变异 胆总管隔膜 诊断 

分 类 号：R686[医药卫生—骨科学]