2例Ⅴb型双胆总管变异报道并文献复习

Report of Two Cases of Type Ⅴb of Double Common Bile Duct and Review of The Literature

目的探讨双胆总管(double common bile duct,DCBD)变异在肝胆外科手术中的意义。方法分析笔者所在医院2010年7～12月期间收治的2例DCBD变异患者的临床资料,同时复习了DCBD的相关文献。结果 2例病例中1例在行腹腔镜胆囊切除术时误判右肝管为胆囊管而将其横断;另一例于术中经胆道造影及胆道镜检查证实为DCBD,因合并胆总管囊肿、胆胰管汇合异常(anomalous pancreaticobiliary ductal junction,APBDJ)及原发性肝内外胆管结石而行手术治疗。2例均为Ⅴb型DCBD。复习DCBD英文文献32篇,自1932年始共报道DCBD病例100例,其中以Ⅱ型和Ⅲ型最常见,Ⅴ型DCBD仅报道10例。自1994～2012年中文文献25篇,共收集DCBD 27例,其中以Ⅴ型最常见。本组2例为Ⅴb型DCBD。副胆总管(accessory common bile duct,ACBD)最常见开口于十二指肠、胃及胰管,常见合并症包括结石、APBDJ、胆总管囊肿、肿瘤等。结论 DCBD是极少见的肝外胆管解剖变异,常伴有胆管结石以及胆总管囊肿、APBDJ等其他胆道解剖异常,并潜在致癌的可能;增加了医源性胆管损伤的风险和胆道手术的复杂性,必须引起肝胆外科医师的高度重视。

Object To evaluate the significance of double common bile duct （DCBD） in hepatobiliary surgery. Metbeds The data of diagnosis and treatment of two patients with DCBD in our hospital between Jul. to Dec. 2010 were analyzed retrospective, and the related literatures were reviewed. Results The right hepatic bile duct of DCBD due to mistaking it for cystic duct in 1 case was accidental injuried during laparoscopic cholecystectomy. Another example, the DCBD was confirmed by intraoperative exploration and choledochoscopic examination, at the same time with chole- dochal cyst, anomalous pancreaticobiliary ductal junction （APBDJ）, primary hepatolithus, and choledocholith, and then operation was performed. Two cases were type Vb of DCBD. A total of 32 English literatures were reviewed. Since the beginning of 1932 English literature had reported 100 cases of DCBD. The type lI and type IU were the most common type of DCBD, and the type V only 10 cases. There were 27 cases of DCBD in twenty-five Chinese articles from 1994 to 2012. The type V was the most common type of DCBD. The accessory common bile duct （ACBD） opening in the duod- enum, gastric, and pancreatic duct were the most common. The common complications included stone, APBDJ, choled- ochal cyst, tumor etc. Conclusions DCBD is a very rare anatomic variation of extrahepatic bile duct, often accompanied by calculus of bile duct and common bile duct cyst, APBDJ, and other biliary anatomy abnormality, and potentially carci- nogenic potential. The existence of DCBD may increase the risk of iatrogenic bile duct injury and complexity of biliary operation. In view of this, this abnormality of extrahepatic duct should be paid with close attention during operation.