Clinical implications of aberrant anatomy of the common hepatic duct in liver surgery: a systematic review and meta-analysis.

IF 1.4 4区医学 Q2 Medicine Surgical and Radiologic Anatomy Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI:10.1007/s00276-024-03494-8

Juan José Valenzuela-Fuenzalida, Constanza Avalos-Díaz, Antonia Droguett-Utreras, Javier Guerra-Loyola, Pablo Nova-Baeza, Mathias Orellana-Donoso, Alejandra Suazo-Santibañez, Gustavo Oyanedel-Amaro, Juan Sanchis-Gimeno, Alejandro Bruna-Mejias, Gkionoul Nteli Chatzioglou

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Abstract

Introduction: Knowledge of anatomical variants that affect the hepatic duct (HD) are of particular clinical relevance during hepatobiliary surgical procedures. More specifically, the aberrant anatomy of the common HD is the most common anatomical variation affecting the biliary tree. Below, we describe different classifications of anatomical variants that affect this canal. According to Huang's classification, variations are determined depending on the insertion of the right posterior hepatic duct (RPHD).

Materials and methods: Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases were investigated until January 2024. The methodological quality was assessed with an anatomical studies assurance tool (AQUA). Pooled prevalence was estimated using a random effects model. For the subgroup analysis, Student's T-test was used.

Results: The prevalence rate of aberrant hepatic duct (AHD) was 15% (confidence interval [CI] of 7-22%). The first subgroup had cadavers and images. For the cadavers, the prevalence was 15.83% (CI: 11.22-18.3%), while the images had a prevalence of 22.06% (CI: 18.12-25.33%). This subgroup analysis showed no statistically significant difference between these groups (p = 0.127). The second subgroup comprised the continents where the included studies were from. In this subgroup, no statistically significant differences were found (p = 0.613). Finally, regarding the right or left laterality of the HD variant, there were no statistically significant differences (p = 0.089).

Conclusion: A AHD corresponds to a finding that can occur in a significant percentage of our society, which could be an accidental discovery during surgeries or present asymptomatically throughout life and be a cadaveric discovery later. We believe it is important for surgeons to have prior knowledge of the possible variants of HD to prevent possible complications during and after surgery.

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肝总管解剖异常对肝脏手术的临床影响：系统回顾和荟萃分析。

导言：了解影响肝管（HD）的解剖变异对肝胆外科手术具有特殊的临床意义。更具体地说，普通肝管的异常解剖是影响胆管的最常见解剖变异。下面，我们将介绍影响该管道解剖变异的不同分类。根据黄氏分类法，变异取决于右后肝管（RPHD）的插入位置：对截至 2024 年 1 月的 Medline、Scopus、Web of Science、Google Scholar、CINAHL 和 LILACS 数据库进行了调查。采用解剖学研究保证工具（AQUA）对方法学质量进行了评估。采用随机效应模型估算了汇总患病率。亚组分析采用学生 T 检验：结果：异常肝管（AHD）的患病率为 15%（置信区间 [CI] 为 7-22%）。第一分组包括尸体和图像。尸体的发病率为 15.83%（置信区间：11.22-18.3%），而图像的发病率为 22.06%（置信区间：18.12-25.33%）。该分组分析表明，这两组之间没有明显的统计学差异（P = 0.127）。第二个分组包括纳入研究的各大洲。在这一分组中，没有发现有统计学意义的差异（P = 0.613）。最后，关于HD变异的右侧或左侧，也没有发现有统计学意义的差异（p = 0.089）：AHD在社会中占很大比例，可能是在手术中意外发现，也可能终生无症状，后来在尸体中发现。我们认为，外科医生必须事先了解 HD 的可能变异，以防止手术中和手术后可能出现的并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical and Radiologic Anatomy Medicine-Pathology and Forensic Medicine

CiteScore

2.40

自引率

14.30%

发文量

期刊介绍： Anatomy is a morphological science which cannot fail to interest the clinician. The practical application of anatomical research to clinical problems necessitates special adaptation and selectivity in choosing from numerous international works. Although there is a tendency to believe that meaningful advances in anatomy are unlikely, constant revision is necessary. Surgical and Radiologic Anatomy, the first international journal of Clinical anatomy has been created in this spirit. Its goal is to serve clinicians, regardless of speciality-physicians, surgeons, radiologists or other specialists-as an indispensable aid with which they can improve their knowledge of anatomy. Each issue includes: Original papers, review articles, articles on the anatomical bases of medical, surgical and radiological techniques, articles of normal radiologic anatomy, brief reviews of anatomical publications of clinical interest. Particular attention is given to high quality illustrations, which are indispensable for a better understanding of anatomical problems. Surgical and Radiologic Anatomy is a journal written by anatomists for clinicians with a special interest in anatomy.