CAJ | 학술논문

目的探讨磁共振胰胆管成像( MRCP)在成人活体右半供肝术前胆道评估中的应用.方法 76例活体肝移植供者,均切取右半肝用于移植.脂肪餐后进行术前MRCP检查,比较MRCP胆管分型与术中胆道造影胆管分型的一致性；在MRCP图像上测量右后肝管汇入部距左右肝管汇合部的距离及相应右后肝管的直径,对相应胆管测量长度及直径与术中胆道重建方式进行二分类Logistic回归分析,并得出术中胆道是否成形的ROC曲线及其长度临界值.结果 MRCP胆管分型与术中胆道造影胆管分型的符合率为97.4％.MRCP所测右后肝管汇入部距左右肝管汇合部的距离和胆管分型是术中胆道重建方式的重要影响因素,而右后肝管直径对术中胆道重建方式的选择无影响.胆道解剖结构变异或Ⅰ型胆管(MRCP分型)中右肝管长度≤4.2mm时,95％的供肝胆道断端数多于1支,且95％行胆道成形术；Ⅲ、Ⅳ型胆管(MRCP分型)所测胆管长度为3.8mm,是选择胆道成形术的分界点.结论 MRCP胆管分型能准确反映胆道解剖结构,MRCP右后肝管汇入部距左右肝管汇合部距离测量值可以指导术中胆道重建方式的选择.
목적 탐토자공진이담관성상( MRCP)재성인활체우반공간술전담도평고중적응용.방법 76례활체간이식공자,균절취우반간용우이식.지방찬후진행술전MRCP검사,비교MRCP담관분형여술중담도조영담관분형적일치성；재MRCP도상상측량우후간관회입부거좌우간관회합부적거리급상응우후간관적직경,대상응담관측량장도급직경여술중담도중건방식진행이분류Logistic회귀분석,병득출술중담도시부성형적ROC곡선급기장도림계치.결과 MRCP담관분형여술중담도조영담관분형적부합솔위97.4％.MRCP소측우후간관회입부거좌우간관회합부적거리화담관분형시술중담도중건방식적중요영향인소,이우후간관직경대술중담도중건방식적선택무영향.담도해부결구변이혹Ⅰ형담관(MRCP분형)중우간관장도≤4.2mm시,95％적공간담도단단수다우1지,차95％행담도성형술；Ⅲ、Ⅳ형담관(MRCP분형)소측담관장도위3.8mm,시선택담도성형술적분계점.결론 MRCP담관분형능준학반영담도해부결구,MRCP우후간관회입부거좌우간관회합부거리측량치가이지도술중담도중건방식적선택.
Objective To investigate the clinical application of the distance of biliary duct measured by MRCP in bile duct resection of the donor and biliary reconstruction of recipients in living donor liver transplantation (LDLT) using right lobe graft.Methods Seventy-six living donors received preoperative MRCP after fat meal,who underwent right lobe resection and all had intraoperative cholangiography (IOC) for comparison.The accuracy of preoperative MRCP for biliary types in LDLT donors was analyzed and compared to that of IOC findings.The length of biliary duct between the junction of the right posterior hepatic duct (RPHD) and the junction of the right and left hepatic ducts was measured in MRCP images.The reconstruction of intraoperative data and the length,the diameter were compared,and binary logistic regression and Receiver Operating Characteristic (ROC) curves were calculated.The result included the limitation.Results In comparison to IOC,the accuracy of MRCP after fat meal was 97.4 ％.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP and the biliary type were the influencing factor of intraoperative reconstruction of biliary duct; while the diameter of biliary duct had no influence ROC curves showed that when the length of biliary duct of type Ⅰ was smaller or equal to 4.2 mm,or the biliary anatomy had variation,the number of biliary anastomotic stomas was more than one,and plasty was selected in 95 ％ of donors intraoperatively.The corresponding length of biliary duct of type Ⅲ and type Ⅳ was 3.8 mm,which was the limitation whether biliary plasty was done intraoperatively.Conclusion The type of bile duct in MRCP can reflect the biliary anatomy structure accurately.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP after fat meal can guide the biliary reconstruction intraoperatively and offer reliable basis for optimizing the clinical operation program in adult LDLT.