Safra yolları anatomik varyasyonlarının 3 tesla MRKP ile değerlendirilmesi
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
AMAÇ Safra kesesi ve safra yolları pek çok varyasyon/anomali gösteren ve komşu yapılar ile sıkı bağlantılı oluşumlardır. İntra yada ekstrahepatik safra kanallarında görülebilen anatomik varyasyonlar, cerrahi girişimlerde çeşitli problemlere yol açabilmektedir. Bu nedenle bu yapıların anatomisi ve varyasyonlarının bilinmesi, cerrahisi açısından önemlidir. Bu çalışmadaki amacımız safra yollarındaki anatomik varyasyonların sıklığını 3 Tesla MRKP ile tespit etmekti. MATERYAL VE METOD Yaşları 8 ile 86 arasında değişen (ortalama 52) 335 olgu retrospektif olarak incelendi. MRKP incelemeleri 3 Tesla MR (Achieva Philips Medical System, Netherland ) cihazında, faz dizilimli sargı kullanılarak, SSFSE tekniği ile ağır T2 görüntüler elde edilerek yapılmıştır. Çalışma kapsamındaki 335 hastanın 163 (yaklaşık %49)’ünde anatomik varyasyon tespit edildi. En sık görülen anatomik varyasyon 57 olgu (%17) ile sağ posterior segment dalının sol hepatik kanala açılmasıdır. Takip eden varyasyonlar ; aberan sağ posterior hepatik kanal 19 hastada ( %5.7), trifurkasyon 22 hastada (%6.6), uzun sistik kanal 6 hastada (%1.8), 40 olguda sistik kanalın medial birleşimi (%11.9), 32 olguda distal medial birleşim (%9.6), 7 olguda kısa sistik kanal (%2.1), 1 olguda yukarı lokalizasyonlu safra kesesi (%0.3), 14 olguda ortak hepatik kanal üzerinde vasküler bası (%4.2), 1 olguda pankreatobiliyer bileşke anomalisi (%0.3), kuadrifurkasyon 9 hastada (%2.7), dublikasyon varyantları 1 hastada (%0.3), ana hepatik kanal ile sistik kanalın ampullaya birlikte açılması 1 hastada (%0.3), 32 olguda ise birden fazla sayıda anatomik varyasyon saptanmıştır (%9.5). SONUÇ MRKP, biliyer anatomi ve varyasyonların gösterilmesinde yararlı, hızlı, tekrarlanabilir ve noninvazif bir inceleme yöntemidir. Cerrahi girişim öncesi bu anatomik varyasyonların gösterilmesi, olası iyatrojenik travmaları önleyebilmektedir.
PURPOSE They display a lot of variations/abnormalities and makes close relations with adjacent structures. Anatomic variations of intra or extrahepatic bile ducts may be problematic during surgical procedures. Therefore, it is important to know their anatomy and variations for the surgery of these structures. The aim of this study was to determine the anatomical variations of the biliary tree with MRCP. MATERIALS AND METHODS 335 patients with ages ranging from 8 to 86 (median: 52) were included in the study retrospectively. MRCP was performed on a 3 Tesla (Achieva Philips Medical System, Netherland ) MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSFSE technique. RESULTS In 163 of the 335 patients (approximately 49%), anatomical variations were determined. The most frequently seen anatomical variation was right posterior sectorial duct joining the left sectorial duct (57 cases ,%17 %), fallowed by the an aberrant right posterior hepatic duct in 19 patients (5.7%), trifurcation in 22 patients (6.6%), a long cystic duct in 6 patients (1.8%), a medial cystic duct insertion in 40 patients(11.9%), a low medial cystic duct insertion in 32 patients (9.6%), a short cystic duct in 7 patient (2.1%), a high localized gallbladder in 1 patients (0.3%), a vascular compression of common hepatic duct in 14 patients (4.2%), a pancreatobiliary junction anomaly in 1 patients (0.3%), quadrifurcation in 9 patients (2.7%), dublication varyant 1 patient (0.3%), pancreas divisum 1 patient (0.3%) with the opening of the main hepatic duct with cystic duct insertion ampulla 1 patients (0.3%)32 patients had more than one anatomic variation (9.5%). CONCLUSION MRCP is a useful, rapid, and non-invasive method for demonstrating the anatomy and the variations of the biliary tree. Diagnosis of these anatomic variations prior to surgical procedures may prevent iatrogenic injury to bile ducts.
PURPOSE They display a lot of variations/abnormalities and makes close relations with adjacent structures. Anatomic variations of intra or extrahepatic bile ducts may be problematic during surgical procedures. Therefore, it is important to know their anatomy and variations for the surgery of these structures. The aim of this study was to determine the anatomical variations of the biliary tree with MRCP. MATERIALS AND METHODS 335 patients with ages ranging from 8 to 86 (median: 52) were included in the study retrospectively. MRCP was performed on a 3 Tesla (Achieva Philips Medical System, Netherland ) MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSFSE technique. RESULTS In 163 of the 335 patients (approximately 49%), anatomical variations were determined. The most frequently seen anatomical variation was right posterior sectorial duct joining the left sectorial duct (57 cases ,%17 %), fallowed by the an aberrant right posterior hepatic duct in 19 patients (5.7%), trifurcation in 22 patients (6.6%), a long cystic duct in 6 patients (1.8%), a medial cystic duct insertion in 40 patients(11.9%), a low medial cystic duct insertion in 32 patients (9.6%), a short cystic duct in 7 patient (2.1%), a high localized gallbladder in 1 patients (0.3%), a vascular compression of common hepatic duct in 14 patients (4.2%), a pancreatobiliary junction anomaly in 1 patients (0.3%), quadrifurcation in 9 patients (2.7%), dublication varyant 1 patient (0.3%), pancreas divisum 1 patient (0.3%) with the opening of the main hepatic duct with cystic duct insertion ampulla 1 patients (0.3%)32 patients had more than one anatomic variation (9.5%). CONCLUSION MRCP is a useful, rapid, and non-invasive method for demonstrating the anatomy and the variations of the biliary tree. Diagnosis of these anatomic variations prior to surgical procedures may prevent iatrogenic injury to bile ducts.
Açıklama
Anahtar Kelimeler
Safra kanalları, Bile ducts, Safra, Bile, Kolanjiyopankreatografi-endoskopik retrograd, Cholangiopancreatography-endoscopic retrograde, Manyetik rezonans görüntüleme, Magnetic resonance imaging
