Clinical summary of 3 265 cases of cystic duct variation in laparoscopic cholecystectomy / 局解手术学杂志

ABSTRACT

Objective To make a clinical summary of the variation of cystic duct so as to collect 20 years of operative experience and to provide evidence for preventing injury of bile duct in laparoscopic cholecystectomy. Methods A retrospective analysis were made for 20 000 patients experienced laparoscopic cholecystectomy in the second affiliated hospital of Chongqing medical university and Chonggang General Hospital from April,1993 to December,2011. Results There were 3 265 cases of cystic duct variation which occupied 16. 33% of the 20 000 patients. And there were 3 200 cases of variation in the junction of cystic duct, 51 cases of short cystic duct;and 14 cases of gall-bladder surrounded by the liver. Most of the variation were found in the junction of cystic duct, including 371 cases (11. 36%) of cystic duct accompanied the common hepatic duct and then made a lower confluence;995 cases (30. 47%) of cystic duct traversed above the com-mon hepatic duct and then made a confluence, 643 cases (19. 69%) of cystic duct traversed below the common hepatic duct and then made a confluence;963 cases (29. 49%) of gallbladder neck attached to the common bile duct;and 228 cases (6. 98%) of higher confluence of cystic duct and common bile duct. Conclusion The rate of cystic duct variation accounted for a high rate, and most of the patients were found with a variation in the junction of cystic duct. Being familiar with the categories of cystic duct, discriminating the anatomic structure carefully, using choledochoscopic examination when necessary, and masterting reasonable time to make a transfer to laparocholecystotomy were reliable methods for coping with the injury of bile duct caused by variation of cystic duct.