胆囊管的磁共振胰胆管成像分型及其临床应用

MRCP classification of cystic duct and its cfinical applica-tion

磁共振胰胆管造影（MRCP）能多方位、多角度显示胆道三维立体形态。腹腔镜经胆囊管处理肝外胆管结石优势明显，但胆囊管形态复杂多变，部分患者并不适宜经该途径手术。因此，如何筛选手术方式显得很重要。本文通过分析MRCP图像，将96例胆总管结石病例的胆囊管分成4类，前瞻性地选择手术方案。对照分析相关数据后我们认为，粗直型宜选择经胆囊管途径；细弯型选择胆管切开途径；变异型及显示不清型则根据具体形态，慎行腹腔镜手术。此方法可最大限度发挥腔镜的微创优势。

MRCP can be applied to display three-di- mensional morphology of the biliary tract clearly. Laparoscopic surgery via cystic duct for choledoeholithiasis possesses obvious advantages, but it is not suitable for all cases because there are great variations in the cystic duct. So how to make proper choice of the therapeutic strategy becomes very important. In this pro- spective study, different surgeries were administrated in patients with common bile duct stone based on the 4 categories of cystic ducts in 96 cases judged by MRCP images. These findings dem- onstrated that according to the cystic duct morphological type, LCTBDE is suitable for thick-straight type, and LCBDE is fit for thin-crooked type. Be careful to choose laparoscopic surgery in the other two types considering their individual features. Thus, this classification will be propitious to maximize the advantage of laparoscopic operation as a minimally invasive treatment.