磁共振胰胆管成像在成人活体右半供肝术前胆道评估中的应用

Application of MRCP in the preoperative biliary assessment of donors before adult living donor liver transplantation using right lobe graft

目的探讨磁共振胰胆管成像（MRCP）在成人活体右半供肝术前胆道评估中的应用。方法76例活体肝移植供者，均切取右半肝用于移植。脂肪餐后进行术前MRCP检查，比较MRCP胆管分型与术中胆道造影胆管分型的一致性；在MRCP图像上测量右后肝管汇入部距左右肝管汇合部的距离及相应右后肝管的直径，对相应胆管测量长度及直径与术中胆道重建方式进行二分类Logistic回归分析，并得出术中胆道是否成形的ROC曲线及其长度临界值。结果MRCP胆管分型与术中胆道造影胆管分型的符合率为97．4％。MRCP所测右后肝管汇人部距左右肝管汇合部的距离和胆管分型是术中胆道重建方式的重要影响因素，而右后肝管直径对术中胆道重建方式的选择无影响。胆道解剖结构变异或Ⅰ型胆管（MRCP分型）中右肝管长度≤4．2min时，95％的供肝胆道断端数多于1支，且95％行胆道成形术；Ⅲ、Ⅳ型胆管（MRCP分型）所测胆管长度为3．8min，是选择胆道成形术的分界点。结论MRCP胆管分型能准确反映胆道解剖结构，MRCP右后肝管汇人部距左右肝管汇合部距离测量值可以指导术中胆道重建方式的选择。

Objective To investigate the clinical application of the distance of biliary duct measured by MRCP in bile duct resection of the donor and biliary reconstruction of recipients in living donor liver transplantation （LDLT） using right lobe graft. Methods Seventy-six living donors received preoperative MRCP after fat meal, who underwent right lobe resection and all had intraoperative cholangiography （IOC） for comparisorL The accuracy of preoperative MRCP for biliary types in LDLT donors was analyzed and compared to that of IOC findings. The length of biliary duct between the junction of the right posterior hepatic duct （RPHD） and the junction of the right and left hepatic ducts was measured in MRCP images. The reconstruction of intraoperative data and the length, the diameter were compared, and binary logistic regression and Receiver Operating Characteristic （ROC） curves were calculated. The result included the limitation. Results In comparison to IOC, the accuracy of MRCP after fat meal was 97. 4 %. The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP and the biliary type were the influencing factor of intraoperative reconstruction of biliary duct; while the diameter of biliary duct had no influence. ROC curves showed that when the length of biliary duct of type Ⅰ was smaller or equal to 4. 2 mm, or the biliary anatomy had variation, the number of biliary anastornotic stomas was more than one, and plasty was selected in 95 % of donors intraoperatively. The corresponding length of biliary duct of type Ⅲ and type Ⅳ was 3. 8 mm, which was the limitation whether biliary plasty was done intraoperatively. Conclusion The type of bile duct in MRCP can reflect the biliary anatomy structure accurately. The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP after fat meal can guide the biliary reconstruction intraoperatively and offer reliable basis for optimizing the clinical operation program in adult LDLT.