活体造影法肝内胆管的解剖学研究及临床意义

Study of anatomy and variation of intrahepatic biliary ducts through cholangiography and its clinical significance

目的通过经皮胆道直接造影,研究肝内胆管的解剖与变异的类型与分布。方法经皮胆道造影50例,用20 ml注射器接体外引流管进行造影,胆管充分显影的状态下,旋转拍摄胆管,观察胆管解剖与变异。结果 50例成像中胆管变异42.0%(21例)。12.0%(6例)显示右前叶肝管、右后叶肝管及肝左管呈三分叉状汇合形成肝总管。8.0%(4例)肝左管先和右前叶肝管汇合,在肝门处与右后叶肝管汇合。20.0%(10例)肝左管先和右后叶肝管汇合,在肝门处与右前叶肝管汇合。2.0%(1例)多个肝管在肝门处汇合。结论胆管解剖与变异的分析对术前手术方式的确定有一定的临床意义。

Objective To observe the anatomy of the bile ducts and its variation through revolving radiography of the bile ducts by percutaneous transhepatic cholangiography （PTC）. Methods 50 cases of PTC were carried out with 20ml syringe connected to external drainage tube and the bile duct anatomy and the variation were observed by revolving radigography of the bile ducts at the fully developing status. Results The variation of the bile ducts was revealed in 21 of 50 cases, accouting 42%.In 6 cases, accounting for 12%, intrahepatic bile ducts of the right anterior lobe, intrahepatic bile ducts of the right posterior lobe and left bile ducts united to form the common bile duct; In 4 cases, accounting for 8.0%, the left bile ducts first converged with the intrahepatic bile ducts of the right anterior lobe, and then they converged with the intrahepatic bile ducts of the right posterior lobe at the hepatic portal; in 10 cases, accounting for 20.0%）, the left bile ducts converged first with the intrahepatic bile ducts of the right posterior lobe, and then they converged with intrahepatic bile ducts of the right anterior lobe at the hepatic portal; in 1 case, accounting for 2.0%, multiple bile ducts formed the common bile duct at the hepatic portal. Conclusion Analysis of the bile duct anatomy and the variation holds a clinical significance on determination of the operative pattern.