胆囊管解剖变异与胆囊结石和肝内胆管结石相关性的MRI研究

发布时间：2018-06-22 18:32

本文选题：胆囊管 + 解剖　；参考：《川北医学院》2015年硕士论文

【摘要】：目的:探讨胆囊管解剖变异(简称变异)与胆囊结石、肝内胆管结石的相关性。材料与方法:收集2013年1月至2014年6月在川北医学院附属医院行中上腹部MRI、磁共振胰胆管造影术(Magnetic Resonance Cholangiopancreatography,MRCP)检查患者的MRI及临床资料。根据MRCP及常规MRI序列上胆囊管汇合高低、方位及走行方式进行分析,将胆囊管分为以下几种类型:1)中位胆囊管,胆囊管汇合于肝外胆管上1/2段,包括:中位右侧壁(正常胆囊管)、前壁、后壁、左侧壁汇合和中位汇合伴并行走行(简称中位并行);2)低位胆囊管:胆囊管汇合于肝外胆管下1/2段,包括:单纯低位汇合(简称低位汇合)和低位汇合伴并行走行(简称低位并行);3)汇合于肝胆管:胆囊管汇合于副肝管、肝左管、肝右管或肝左管、肝右管分支及其肝门汇合处;4)短胆囊管,胆囊管长度短于5mm。胆囊结石诊断符合以下标准之一:1)手术证实有胆囊结石,2)MRI与B超/CT诊断有胆囊结石,3)无B超/CT检查记录,但在MRI序列上具有典型结石征象。肝内胆管结石诊断符合以下标准之一:1)手术证实有肝内胆管结石,2)经MRI与B超/CT诊断有肝内胆管结石,3)无B超/CT检查记录,但在MRI序列上具有典型肝内胆管结石征象。利用SPSS13.0软件比较各型变异胆囊管患者与正常胆囊管患者胆囊结石、肝内胆管结石患病率差异。结果：1、737例患者中,正常汇合胆囊管324例(43.96%);变异胆囊管合计413例(56.04%),其中胆囊管中位前壁汇合36例(4.88%),中位后壁汇合186例(25.24%),中位左侧壁汇合36例(4.88%),中位并行15例(2.04%),低位汇合48例(6.51%),低位并行49例(6.65%),汇合于肝胆管34例(4.61%),短胆囊管9例(1.22%)。2、变异胆囊管中,仅胆囊管低位汇合、胆囊管低位汇合伴并行走行患者结石患病率(分别为43.75%、46.94%)较正常胆囊管患者胆囊结石患病率(25.31%)差异有统计学意义(P0.05)。3、各变异胆囊管患者肝内胆管结石患病率与正常胆囊管患者肝内胆管结石患病率差异无统计学意义(P0.05)。结论：1、胆囊管变异率较高,变异胆囊管中胆囊管低位汇合、胆囊管低位汇合伴并行走行能够促进胆囊结石发病。2、各型变异胆囊管患者肝内胆管结石患病率与正常胆囊管患者相近,胆囊管变异与肝内胆管结石发病无相关性。
[Abstract]:Objective: to investigate the relationship between the anatomic variation of gallbladder duct and cholecystolithiasis and intrahepatic cholelithiasis. Materials and methods: magnetic Resonance cholangiopancreatography (MRCP) and magnetic Resonance cholangiopancreatography (MRCP) were performed at the affiliated Hospital of North Sichuan Medical College from January 2013 to June 2014. According to MRCP and conventional MRI sequence, the level, orientation and walking mode of cystic duct confluence were analyzed. The cystic duct was divided into the following types: 1: 1) median gallbladder duct, and gallbladder duct confluent in 1 / 2 segment of extrahepatic bile duct. Including: median right wall (normal cystic duct), anterior wall, posterior wall, left wall confluence and median confluence with parallel (median parallel) 2) low gallbladder duct: cholecystic duct converges at 1 / 2 segment of the extrahepatic bile duct. Including: simple low confluence (abbreviated as low confluence) and low confluence with parallel walk (low parallel) confluence in hepatobiliary duct: gallbladder duct confluence in accessory hepatic duct, left hepatic duct, right hepatic duct or left hepatic duct, The branch of the right hepatic duct and the junction of the hepatic hilus 4) short gallbladder duct, the length of the cholecystic duct is shorter than 5 mm. The diagnosis of cholecystolithiasis accords with one of the following criteria: 1: 1) the diagnosis of cholecystolithiasis was confirmed by operation. 2) MRI and B-scan / CT were used to diagnose gallstone. 3) there was no B-US / CT scan, but there were typical signs of gallstone on MRI sequence. The diagnosis of intrahepatic cholelithiasis was in accordance with one of the following criteria: 1: 1) intrahepatic cholelithiasis was confirmed by operation. (2) Intrahepatic cholangiolithiasis was diagnosed by MRI and B-ultrasound / CT (3) there was no B-ultrasound / CT scan, but typical intrahepatic cholelithiasis was found on MRI sequence. SPSS 13.0 software was used to compare the prevalence of cholecystolithiasis and intrahepatic cholelithiasis in patients with variant cystic duct and normal cystic duct. Results out of 1, 1737 patients, 324 cases (43.96%) had normal confluence of gallbladder duct, 413 cases (56.04%) were variant cystic duct, including 36 cases (4.88%) with median anterior wall confluence, 186 cases (25.24%) with median posterior wall confluence, 36 cases (4.88%) with median left wall confluence, 15 cases (2.04%) with median conjunctions, 48 cases (6.51%) with low level confluence. 49 cases (6.65%) were performed, 34 cases (4.61%) were converged in hepatobiliary duct, 9 cases (1.22%) were short gallbladder duct. Cholecystic duct confluence only, The incidence of cholecystolithiasis in patients with low confluence of gallbladder duct with parallel walking (43.75%) was significantly higher than that in patients with normal cystic duct (25.31%) (P0.05). The incidence of intrahepatic cholelithiasis in patients with variant gallbladder duct was higher than that in normal gallbladder duct (P < 0.05). There was no significant difference in the prevalence of intrahepatic cholelithiasis in patients with cystic duct (P0.05). Conclusion the mutation rate of gallbladder duct is higher than that of% 1, and the low confluence of gallbladder duct in variant gallbladder duct. The incidence rate of intrahepatic cholelithiasis in patients with variant cystic duct was similar to that in normal patients, but there was no correlation between cholecystic duct variation and intrahepatic cholelithiasis.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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