胆嚢摘出後の胆嚢床からの胆管漏れ：ルシュカ管または肝性溶解性管？

胆道の解剖学的変動は一般的であり、胆嚢摘出術が行われると困難を引き起こす可能性があります。最も一般的なものの1つは、肝臓のダクトとルシュカ管です。胆嚢またはそのベッドを胆管に接続しますが、これら2つのタイプのダクト間の区別は困難です。ここでは、これらの解剖学的変動、それらの起源と臨床的意味の違いについて説明します。これらの異常なダクトは気付かれず、術後胆道漏れの場合にさらに補完的な手順を必要とする場合があります。介入の終わりに慎重な外科的処置と嚢胞層の検査に加えて、術中の胆管造影をできるだけ頻繁に実施する必要があります。

Anatomic variations in the biliary tract are common and can cause difficulties when a cholecystectomy is performed. One of the most common ones are hepaticocholecystic ducts and Luschka ducts, connecting the gallbladder or its bed to the bile ducts but distinction between these two types of ducts can be difficult. We do discuss here the differences between these anatomical variations, their origin and their clinical implications. These aberrant ducts may go unnoticed and may require further complementary procedures in case of postoperative biliary leakage. In addition to a careful surgical procedure and an examination of the cystic bed in the end of the intervention, an intraoperative cholangiography should be performed as often as possible.