A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy
A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy
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DOI：
10.1007/s00464-020-07610-8
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发表时间：
2020-05-06
影响因子：
3.1
通讯作者：
Sano, Tsuyoshi
中科院分区：
文献类型：
--
作者：
Kurahashi, Shintaro;Komatsu, Shunichiro;Sano, Tsuyoshi
背景基于迷走右肝管（ARHD）与胆囊管和胆囊颈的空间关系，我们提出了一种实用的分类方法来评估腹腔镜胆囊切除术（LC）中易损伤的具体形式。方法我们回顾性调查了2015年至2018年在我院接受LC的721例连续患者的术前影像（主要是磁共振胰胆管成像）和临床结局。我们将高危ARHD定义如下：A型：与胆囊管相通，B型：沿胆囊颈沿着或靠近漏斗部（与ARHD的最小距离< 5 mm），无论胆道系统的汇合模式如何。其他ARHD被认为是低风险的。结果16例（2.2%）患者中确定为高危ARHD，其中A型解剖4例（0.6%），B型12例（1.7%）。其余ARHD病例（n = 34，4.7%）被归类为低风险。高风险组和低风险组之间的手术结局（手术时间、失血量、住院时间）无显著差异。高风险组中有4例（25%）实施了胆囊大部切除术，显著高于低风险组（n = 1，2.9%）。在所有高危ARHD患者中，LC均安全完成，无胆管损伤或中转开腹。结论我们对高风险ARHD的简单分类可以突出靠近解剖部位的变异，以达到安全性的关键观点，并可能有助于避免LC中ARHD的意外损害。
Background Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). Methods We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. Results A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. Conclusions Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.