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Abstract：
BACKGROUND: Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored.
OBJECTIVE: To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones.
METHODS: A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis.
RESULTS: Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones.
CONCLUSIONS: The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.
OBJECTIVE: To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones.
METHODS: A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis.
RESULTS: Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones.
CONCLUSIONS: The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.
摘要：
背景：胆结石是通常需要手术干预的常见病变。腹腔镜胆囊切除术是治疗有症状胆结石的首选方法。术前,胆囊管（CD）的解剖形态，需要被准确识别，尤其是当CD中发生解剖学变化时，否则容易造成胆管损伤。然而,目前,目前尚无适用于临床实践的CD形态学最佳分类系统，CD的解剖变异与胆结石之间的关系仍有待探索。
目的：建立更全面的临床适用的CD形态学分类，并探讨CD的解剖变异与胆结石之间的相关性。
方法：从2021年10月至2022年1月，回顾性纳入了300例患者。将患者分为两组：胆结石组和非胆结石组。收集并分析了基于磁共振胰胆管造影（MRCP）的CD的相关临床数据和解剖数据，以提出CD的形态分类系统并探讨其与胆结石的关系。使用logistic回归分析进行多变量分析，以使用在单变量分析中有意义的变量来确定独立危险因素。
结果：在这项研究的300名患者中，200例（66.7%）有胆结石。平均年龄48.10±13.30岁,142人（47.3%）为男性，女性为158人(52.7%)。共有55.7％的患者的体重指数（BMI）≥24kg/m2。基于MRCP,CD解剖类型分为四种类型：I型：线性，II型:n型,III型：S形，IV型：W形。单变量分析显示胆结石和非胆结石组之间的性别差异，BMI,胆固醇,甘油三酯，CD的形态，CD插入肝外胆管的部位，CD的长度,以及肝总导管和CD之间的角度。根据多变量分析，女性,BMI（≥24kg/m2），和CD形态[n形：赔率比（OR）=10.97，95％置信区间（95CI）：5.22-23.07，P<0.001；S形：OR=4.43，95CI：1.64-11.95，P=0.003；W形：OR=7.74，95CI：1.88-31.78，P=0.005]与胆结石显著相关。
结论：本研究详述了CD的形态变异，并证实CD曲折是胆结石的独立危险因素。
目的：建立更全面的临床适用的CD形态学分类，并探讨CD的解剖变异与胆结石之间的相关性。
方法：从2021年10月至2022年1月，回顾性纳入了300例患者。将患者分为两组：胆结石组和非胆结石组。收集并分析了基于磁共振胰胆管造影（MRCP）的CD的相关临床数据和解剖数据，以提出CD的形态分类系统并探讨其与胆结石的关系。使用logistic回归分析进行多变量分析，以使用在单变量分析中有意义的变量来确定独立危险因素。
结果：在这项研究的300名患者中，200例（66.7%）有胆结石。平均年龄48.10±13.30岁,142人（47.3%）为男性，女性为158人(52.7%)。共有55.7％的患者的体重指数（BMI）≥24kg/m2。基于MRCP,CD解剖类型分为四种类型：I型：线性，II型:n型,III型：S形，IV型：W形。单变量分析显示胆结石和非胆结石组之间的性别差异，BMI,胆固醇,甘油三酯，CD的形态，CD插入肝外胆管的部位，CD的长度,以及肝总导管和CD之间的角度。根据多变量分析，女性,BMI（≥24kg/m2），和CD形态[n形：赔率比（OR）=10.97，95％置信区间（95CI）：5.22-23.07，P<0.001；S形：OR=4.43，95CI：1.64-11.95，P=0.003；W形：OR=7.74，95CI：1.88-31.78，P=0.005]与胆结石显著相关。
结论：本研究详述了CD的形态变异，并证实CD曲折是胆结石的独立危险因素。
