CAJ | 학술논문

目的：总结中国人群胆囊管变异的临床情况并结合近20年的手术经验，为腹腔镜胆囊手术预防胆管损伤提供临床依据。方法对重庆医科大学附属第二医院及重庆重钢总医院1993年4月至2011年12月总共20000例腹腔镜胆囊切除术患者的临床资料进行回顾性分析。结果胆囊管变异3265例，变异率为16.33%，其中胆囊管汇入点变异3200例，短胆囊管51例，胆囊被肝组织包绕14例。胆囊管汇入点的变异占绝大部分，其中胆囊管与肝总管平行低位汇合371例，占11.36%；胆囊管横过肝总管前面汇入995例，占30.47%；胆囊管绕过肝总管后面再汇入643例，占19.69%；胆囊颈部之囊状凸与胆总管粘在一起963例，占29.49%；胆囊管与胆总管高位汇合228例，占6.98%。结论中国人群胆囊管变异以胆囊管汇入点异常为主；临床医师术中应熟悉胆囊管变异的分型，术中仔细认清解剖结构，必要时采取术中胆道影像学检查并且掌握好中转开腹指征。
목적：총결중국인군담낭관변이적림상정황병결합근20년적수술경험，위복강경담낭수술예방담관손상제공림상의거。방법대중경의과대학부속제이의원급중경중강총의원1993년4월지2011년12월총공20000례복강경담낭절제술환자적림상자료진행회고성분석。결과담낭관변이3265례，변이솔위16.33%，기중담낭관회입점변이3200례，단담낭관51례，담낭피간조직포요14례。담낭관회입점적변이점절대부분，기중담낭관여간총관평행저위회합371례，점11.36%；담낭관횡과간총관전면회입995례，점30.47%；담낭관요과간총관후면재회입643례，점19.69%；담낭경부지낭상철여담총관점재일기963례，점29.49%；담낭관여담총관고위회합228례，점6.98%。결론중국인군담낭관변이이담낭관회입점이상위주；림상의사술중응숙실담낭관변이적분형，술중자세인청해부결구，필요시채취술중담도영상학검사병차장악호중전개복지정。
Objective To make a clinical summary of the variation of cystic duct so as to collect 20 years of operative experience and to provide evidence for preventing injury of bile duct in laparoscopic cholecystectomy. Methods A retrospective analysis were made for 20 000 patients experienced laparoscopic cholecystectomy in the second affiliated hospital of Chongqing medical university and Chonggang General Hospital from April,1993 to December,2011. Results There were 3 265 cases of cystic duct variation which occupied 16. 33% of the 20 000 patients. And there were 3 200 cases of variation in the junction of cystic duct, 51 cases of short cystic duct;and 14 cases of gall-bladder surrounded by the liver. Most of the variation were found in the junction of cystic duct, including 371 cases (11. 36%) of cystic duct accompanied the common hepatic duct and then made a lower confluence;995 cases (30. 47%) of cystic duct traversed above the com-mon hepatic duct and then made a confluence, 643 cases (19. 69%) of cystic duct traversed below the common hepatic duct and then made a confluence;963 cases (29. 49%) of gallbladder neck attached to the common bile duct;and 228 cases (6. 98%) of higher confluence of cystic duct and common bile duct. Conclusion The rate of cystic duct variation accounted for a high rate, and most of the patients were found with a variation in the junction of cystic duct. Being familiar with the categories of cystic duct, discriminating the anatomic structure carefully, using choledochoscopic examination when necessary, and masterting reasonable time to make a transfer to laparocholecystotomy were reliable methods for coping with the injury of bile duct caused by variation of cystic duct.