The Identification And Classification Of The Variation Of The Accessory Hepatic Duct By MRCP

Objectives:To investigate the value of MRCP in the variation of the accessory hepatic duct and the incidence of the accessory hepatic duct, and to explore the variation and typing of the accessory hepatic duct; To explore the correlation between the variation of the accessory hepatic duct and the gender and age, and provide valuable information for the preoperative plan of biliary tract, and to reduce and avoid the occurrence of iatrogenic biliary tract injury.Methods:1. Abdominal MRCP examination are collected and evaluated by two experienced physicians with no accessory hepatic duct; And the patients are grouped according to age and gender, there are or are not differences among different age groups and different gender groups.2. Patients who MRCP is found to exist accessory hepatic duct variation are divided according to the import part of the accessory hepatic duct, Type â… :right accessory hepatic duct drain into the common hepatic duct; Type â…¡:right accessory hepatic duct drain into the common bile duct; Type â…¢:right accessory hepatic duct drain into the left hepatic duct; Type â…£:right accessory hepatic duct drain into the right hepatic duct; Type V:right accessory hepatic duct and left hepatic duct and right hepatic duct confluence of common hepatic duct; Type VI:right accessory hepatic duct, common hepatic duct and cystic duct confluence of common bile duct; Type â…¦:right accessory hepatic duct drain into cystic duct or cystic duct drain into the right accessory hepatic duct; Type â…§:double accessory hepatic duct; Type â…¨:left accessory hepatic duct.3. According to the distance between the accessory hepatic duct and the inlet of the cystic duct, the accessory hepatic duct is divided into high risk group, medium risk group and low risk group, and statistics for each group. High risk group, including right accessory hepatic duct, common hepatic duct and cystic duct confluence of common bile duct and right accessory hepatic duct drain into cystic duct or cystic duct drain into the right accessory hepatic duct; Medium risk group, including right accessory hepatic duct drain into the common hepatic duct and right accessory hepatic duct drain into the common bile duct; Low risk group, including right accessory hepatic duct drain into the left hepatic duct, right accessory hepatic duct drain into the right hepatic duct, right accessory hepatic duct and left hepatic duct and right hepatic duct confluence of common hepatic duct, double accessory hepatic duct and left accessory hepatic duct drain into common hepatic duct.4. The middle risk group is divided according to age and gender, and there are or are not differences among different age groups and different gender groups.Results:1. This study collect 9026 patients with MRCP,3890 cases of male, female 5136, which has accessory hepatic duct variation of 207 cases, the mutation rate is 2.29%(n = 9026), including 93 cases of male, the mutation rate is 2.39%(n= 3888),114 cases of women, the mutation rate is 2.22%(n= 5136). The correlation between the variation of the accessory hepatic duct and the gender is compared with the x2 test: x2 value= 0.289, P= 0.591, and there is no significant difference in the gender and the variation of the patients; According to the age group, the variation of the accessory hepatic duct is compared with the age of the patients, the value of the x2 test is 2.728, P= 0.742, and there is no significant difference between the different age groups and the variation.2. Among 207 cases of accessory hepatic duct variation, right accessory hepatic duct drain into the common hepatic duct in 152 cases; right accessory hepatic duct drain into the common bile duct in 14 cases; right accessory hepatic duct drain into the left hepatic duct in 8 cases; right accessory hepatic duct drain into the right hepatic duct in 11 cases; right accessory hepatic duct and left hepatic duct and right hepatic duct confluence of common hepatic duct in 10 cases; right accessory hepatic duct, common hepatic duct and cystic duct confluence of common bile duct in 5 cases; right accessory hepatic duct drain into cystic duct or cystic duct drain into the right accessory hepatic duct in 5 cases; double accessory hepatic duct(drain into right hepatic duct and common hepatic duct respectively) in 1 cases; left accessory hepatic duct drain into common hepatic duct in 1 cases. One of the most common types is Type â… , that is, the right accessory hepatic duct into common hepatic duct, accounting for 73.43%.3. High risk group,10 cases, including right accessory hepatic duct, common hepatic duct and cystic duct confluence of common bile duct and right accessory hepatic duct drain into cystic duct or cystic duct drain into the right accessory hepatic duct; Medium risk group,166 cases, including right accessory hepatic duct drain into the common hepatic duct and right accessory hepatic duct drain into the common bile duct; Low risk group,31 cases, including right accessory hepatic duct drain into the left hepatic duct, right accessory hepatic duct drain into the right hepatic duct, right accessory hepatic duct and left hepatic duct and right hepatic duct confluence of common hepatic duct, double accessory hepatic duct and left accessory hepatic duct drain into common hepatic duct.4. The statistical analysis of the distance between the accessory hepatic duct and the inlet of the cystic duct in the middle risk group was performed according to the gender and age. In all patients, the distance between different age groups, with analysis of variance, F= 0.77, P= 0.58, the difference was not statistically significant, that is, the distance between the accessory hepatic duct and the cystic duct was not correlated with the age. In different age groups, the distance between male and female group was two independent samples t test, and the difference was statistically significant (P= 0.04) only in the age group of 71 years old.Conclusions:1. MRCP can be a clear display of the existence of the accessory hepatic duct, The variation of the accessory hepatic duct is not rare. The incidence rate of this group is 2.29%. the incidence of male and female, age are no difference.2. MRCP can be used dividing into the variation of the accessory hepatic duct, among which the most common variation is Type â… , accounting for 73.43% of the total variation.3. Different type and different distance of the cystic duct, so there is the different risk of surgical injury.4. MRCP is helpful to the identification and classification of the variation of accessory hepatic duct, which has positive guiding significance for the development of the preoperative surgical plan and the operation to avoid iatrogenic biliary tract injury.