基于三维可视化技术的肝胆管角度与Ⅵ段胆管结石形成的相关研究

A retrospective correlation study on bile duct angle and hepatolithiasis in liver segmentⅥbased on 3D visual technology imaging

目的探讨肝胆管角度与Ⅵ段胆管结石形成的相关性。方法回顾分析广州医科大学附属第一医院2017年1月至2021年1月收治的46例Ⅵ段胆管结石患者资料并纳入结石组,其中男性18例,女性28例,年龄(55.7±10.5)岁。选择同期的50例胆囊炎患者纳入对照组,其中男性19例,女性31例,年龄(57.4±14.4)岁。建立肝脏三维可视化模型并测量Ⅵ段胆管以及右肝管角度。单因素以及多因素logistic回归分析Ⅵ段胆管结石形成的影响因素。结果结石组Ⅵ段胆管角度(124.5±23.1)°、右肝管角度(83.5±14.4)°,高于对照组(111.8±27.7)°、(76.9±14.8)°,差异有统计学意义(t=2.44、2.10,P=0.017、0.039)。Ⅵ段胆管角度(OR=1.024,95%CI:1.006~1.042,P=0.010)及右肝管角度(OR=1.035,95%CI:1.005~1.065,P=0.020)与Ⅵ段胆管结石形成相关,Ⅵ段胆管和右肝管角度越大,Ⅵ段胆管结石形成风险越大。受试者工作特征曲线分析,Ⅵ段胆管角度等于102.295°时,诊断Ⅵ段胆管结石的灵敏度为91.3%,特异度为34.0%,曲线下面积为0.631。结论Ⅵ段胆管角度及右肝管角度是Ⅵ段胆管结石形成的危险因素。

Objective To study the correlation between biliary angle and hepatolithiasis in liver segmentⅥ.Methods A retrospective analysis of the clinical data of 46 patients with liver segmentⅥbile duct stones treated at the First Affiliated Hospital of Guangzhou Medical University from January 2017 to January 2021 was carried out.There were 18 males and 28 females,with the age of(55.7±10.5)years.During the study period,50 patients with cholecystitis were enrolled to form the control group,which consisted of 19 males and 31 females,with the age of(57.4±14.4)years.The angles of the right hepatic duct and the bile duct in segmentⅥwere measured by the 3D hepatic visualization model.Univariate and multivariate logistic regressions were used to analyze factors correlated with formation of segmentⅥbile duct stones.Results The angles of the segmentⅥbile duct(124.5±23.1)°and the right hepatic duct(83.5±14.4)°in the study group were significantly larger than the control group(111.8±27.7)°,(76.9±14.8)°.The difference was significant(t=2.44,2.10,P=0.017,0.039).Analysis showed that the angles of segmentⅥbile duct(OR=1.024,95%CI:1.006-1.042,P=0.010)and right hepatic duct(OR=1.035,95%CI:1.005-1.065,P=0.020)correlated with bile duct stones in segmentⅥ,with greater the angles,greater were the rates of bile duct stones in segmentⅥ.Receiver operating characteristic curve showed that stones were more commonly formed when the angle of bile duct in segmentⅥwas over 102.295°.The sensitivity,specificity and area under the curve were 91.3%,34.0%and 0.631 respectively.Conclusion The angles of segmentⅥbile duct and right hepatic duct were risk factors associated with segment VI bile duct calculi.