本文選題：膽囊管 + 解剖　； 參考：《川北醫(yī)學院》2015年碩士論文

【摘要】：目的:探討膽囊管解剖變異(簡稱變異)與膽囊結(jié)石、肝內(nèi)膽管結(jié)石的相關性。材料與方法:收集2013年1月至2014年6月在川北醫(yī)學院附屬醫(yī)院行中上腹部MRI、磁共振胰膽管造影術(Magnetic Resonance Cholangiopancreatography,MRCP)檢查患者的MRI及臨床資料。根據(jù)MRCP及常規(guī)MRI序列上膽囊管匯合高低、方位及走行方式進行分析,將膽囊管分為以下幾種類型:1)中位膽囊管,膽囊管匯合于肝外膽管上1/2段,包括:中位右側(cè)壁(正常膽囊管)、前壁、后壁、左側(cè)壁匯合和中位匯合伴并行走行(簡稱中位并行);2)低位膽囊管:膽囊管匯合于肝外膽管下1/2段,包括:單純低位匯合(簡稱低位匯合)和低位匯合伴并行走行(簡稱低位并行);3)匯合于肝膽管:膽囊管匯合于副肝管、肝左管、肝右管或肝左管、肝右管分支及其肝門匯合處;4)短膽囊管,膽囊管長度短于5mm。膽囊結(jié)石診斷符合以下標準之一:1)手術證實有膽囊結(jié)石,2)MRI與B超/CT診斷有膽囊結(jié)石,3)無B超/CT檢查記錄,但在MRI序列上具有典型結(jié)石征象。肝內(nèi)膽管結(jié)石診斷符合以下標準之一:1)手術證實有肝內(nèi)膽管結(jié)石,2)經(jīng)MRI與B超/CT診斷有肝內(nèi)膽管結(jié)石,3)無B超/CT檢查記錄,但在MRI序列上具有典型肝內(nèi)膽管結(jié)石征象。利用SPSS13.0軟件比較各型變異膽囊管患者與正常膽囊管患者膽囊結(jié)石、肝內(nèi)膽管結(jié)石患病率差異。結(jié)果：1、737例患者中,正常匯合膽囊管324例(43.96%);變異膽囊管合計413例(56.04%),其中膽囊管中位前壁匯合36例(4.88%),中位后壁匯合186例(25.24%),中位左側(cè)壁匯合36例(4.88%),中位并行15例(2.04%),低位匯合48例(6.51%),低位并行49例(6.65%),匯合于肝膽管34例(4.61%),短膽囊管9例(1.22%)。2、變異膽囊管中,僅膽囊管低位匯合、膽囊管低位匯合伴并行走行患者結(jié)石患病率(分別為43.75%、46.94%)較正常膽囊管患者膽囊結(jié)石患病率(25.31%)差異有統(tǒng)計學意義(P0.05)。3、各變異膽囊管患者肝內(nèi)膽管結(jié)石患病率與正常膽囊管患者肝內(nèi)膽管結(jié)石患病率差異無統(tǒng)計學意義(P0.05)。結(jié)論：1、膽囊管變異率較高,變異膽囊管中膽囊管低位匯合、膽囊管低位匯合伴并行走行能夠促進膽囊結(jié)石發(fā)病。2、各型變異膽囊管患者肝內(nèi)膽管結(jié)石患病率與正常膽囊管患者相近,膽囊管變異與肝內(nèi)膽管結(jié)石發(fā)病無相關性。
[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.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.4

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