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编号:13339352
应用双源CT评估胆囊动脉终点的解剖变异(2)

     ?偆?19%行膽管修补术的患者术后会出现胆管狭窄,6%?偆?22%的患者出现慢性肝病 [11,14]。虽然胆管损伤的发生率很低,大约为0.3%?偆?0.6%[13],但仅在美国每年就有大约100万例腹腔镜胆囊切除手术[15],因此累及患者的人数还是相当可观的。

    本试验的其它发现与相关文献中的结果一致[2-5]。本试验发现大部分患者(96%)只出现1条胆囊动脉,4%患者出现2例胆囊动脉。 没有患者出现三个或更多的胆囊动脉。 有文献报道,86%患者的胆囊由单一的胆囊动脉供血,14%患者的胆囊同时由两条胆囊动脉供血[7]。

    4 结论

    综上所述,双源CT可以评估胆囊动脉终点的解剖变异;并讨论了这些解剖与减少腹腔镜胆囊切除术术中胆管损伤并发症的潜在关系。

    参考文献

    [1] Haubrich WS. Calot of the triangle of Calot [J]. Gastroenterology, 2002,123 (5):1440.

    [2] Sugita R, Yamazaki T, Fujita N et al. Cystic artery and cystic duct assessment with 64-detector row CT before laparoscopic cholecystectomy[J]. Radiology, 2008 248(1):124-131.

    [3] Chen TH ,Shyu JF, Chen CH, et al. Variations of the cystic artery in Chinese adults[J]. Surg Laparosc Endosc Percutan Tech, 2000, 10(3):154-157.

    [4] Futara G, Ali A, Kinfu Y. Variations of the hepatic and cystic arteries among Ethiopians[J]. Ethiop Med J, 2001, 39(2):133-142.

    [5] Ding YM, Wang B, Wang WX, et al. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy[J]. World J Gastroenterol, 2007, 13(42) :5629-5634.

    [6] Suzuki M, Akaishi S, Rikiyama T, et al. Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply[J]. Surg Endosc, 2000, 14(2):141-144.

    [7] Mlakar B, Gadzijev EM, Ravnik D, et al. Anatomical variations of the cystic artery[J]. Eur J Morphol, 2003, 41(1):31-34.

    [8] Xia J, Zhang Z, He Y, et al. Assessment and classification of cystic arteries with 64-detector row computed tomography before laparoscopic cholecystectomy[J]. Surg Radiol Anat, 2015, 37(9):1027-1034.

    [9] Andall RG, Matusz P, du Plessis M, et al. The clinical anatomy of cystic artery variations: a review of over 9800 cases[J]. Surg Radiol Anat, 2015, 38(5):529-539.

    [10] Chapman WC, Abecassis M, Jarnagin W, et al. Bile duct injuries 12 years after the introduction of laparoscopic cholecystectomy[J]. J Gastrointest Surg, 2003, 7(3):412-416.

    [11] Machado, NO. Biliary complications postlaparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review[J]. Diagn Ther Endosc, 2011, 201: 967017.

    [12] Nakajima J, Sasaki A, Obuchi T, et al. Laparoscopic subtotal cholecystectomy for severe cholecystitis[J]. Surg Today, 2009, 39(10):870-875.

    [13] Saad N, Darcy M. Iatrogenic bile duct injury during laparoscopic cholecystectomy[J]. Tech Vasc Interv Radiol , 2008, 11 (2):102-110.(李莉 侯中华)
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