Sağ Hepatektomi Planlanan Canlı Karaciğer Donör Adaylarında Sol Lob Volümünün Huang Safra Yolu Varyasyonları ile İlişkisi

Amaç: Huang sınıflandırmasına göre, safra kanalı varyasyonlarının canlı donörlerde karaciğer kalıntı hacmi üzerine etkisini araştırmak. Gereç ve Yöntemler: Yüz altmış dokuz canlı donöre ait, trifazik batın Bilgisayarlı Tomografi (BT) ve manyetik rezonans kolanjiopankreatografi (MRKP) görüntüleri retrospektif olarak incelendi. MRKP ile safra yolları huang sınıflamasına göre dört kategoriye ayrıldı. BT görüntülerinden özel bir bilgisayar programıyla (Myrian Pro; Intrasense, Montpellier, France) karaciğer total ve lobar volümleri hesaplandı. Sol lob volümü total volume oranlanarak sol lob volüm yüzdesi bulundu. Huang sınıflaması kategorisel verileri ile sol lob volüm yüzdesi verileri Kruskal-Wallis testi aracılığıyla karşılaştırıldı. İstatistiksel olarak P<0.05 olan değerler anlamlı kabul edildi. Bulgular: Huang sınıflamasına göre kategoriler arasında yaş ve cinsiyet dağılımında istatistiksel fark izlenmedi (sırasıyla; p= 0,756 ve p= 0,124). Karaciğer transplantasyon rezeksiyon hattına (Cantlie hattı) göre hesaplanan remnant sol lob volümleri ile Huang sınıflamasındaki gruplar arasında anlamlı ilişki saptanmadı (p= 0,354). Sonuç: Sağ hepatoktomi planlanan canlı karaciğer vericilerinde safra yollarındaki varyasyonların remnant sol lob volümünü etkilemediği sonucuna varıldı.

Anahtar Kelimeler:

Bilgisayarlı tomografi, Karaciğer kalıntı hacmi, Manyetik rezonans kolanjiopankreatografi, Safra yolu varyasyonları

The Relationship of Left Lobe Volume with Huang Biliary Tract Variations in Living Liver Donor Candidates Planned for Right Hepatectomy

Objective: To investigate the effect of bile duct variations on liver remnant volume in living donors, according to the Huang classification. Material and Methods: Triphasic abdominal Computed Tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) images of one hundred sixty-nine live donors were analyzed retrospectively. Biliary tracts were divided into four categories according to the Huang classification. Liver total and lobar volumes were calculated from CT images with a special computer program (Myrian Pro; Intrasense, Montpellier, France). The volume was proportional to the left lobe volume percentage. The categorical data of the Huang classification and the percentage of left lobe volume were compared using the Kruskal-Wallis test. Values with P <0.05 were considered statistically significant. Results: According to Huang classification, there was no statistical difference in age and gender distribution between categories (P = 0.756 and P = 0.124, respectively). There was no significant relation between the groups in Huang classification and remnant left lobe volumes calculated through the liver transplantation resection line (Cantlie line) (P = 0.354). Conclusion: It was concluded that variations in biliary tract did not affect the remnant left lobe volume in living liver donor candidates planned for right hepatectomy.

Keywords:

Biliary tract variations, Computed tomography, Magnetic resonance cholangiopancreatography, Remnant volume,

PDF

___

Referans1. Andersen V, Sonne J, Sletting S, Prip A. The volume of the liver in patients correlates to body weight and alcohol consumption. Alcohol and Alcoholism 2000; 35 (5): 531–32.
Referans2. Kokudo T, Hasegawa K, Uldry E, Matsuyama Y, Kaneko J, Akamatsu N, Taku Aoki T, Sakamoto Y, Demartines N, Sugawara Y, Kokudo N, Halkiç N. New formula for calculating standard liver volume for living donor liver transplantation without using body weight. J Hepatol 2015; 63(4): 848-54.
Referans3. Choi SH, Kwon JH, Kim KW, Jang HY, Kim JH, Kwon HJ, Lee J, Şarkısı JL,Won G, Lee SG. Measurement of liver volumes by portal vein flow by Doppler ultrasound in living donor liver transplantation. Clin Transplant 2017; 31: e13050.
Referans4. Abdalla EK, Denys A, Chevalier P, Nemr RA, Vauthey JN. Total and segmental liver volume variations: implications for liver surgery. Surgery 2004;135(4):404-10.
Referans5. Basaran C, Agildere AM, Donmez FY, Sevmis S, Budakoglu I, Karakayali H, Haberal M. MR cholangiopancreatography with T2-weighted prospective acquisition correction turbo spin-echo sequence of the biliary anatomy of potential living liver transplant donors. AJR Am J Roentgenol 2008;190(6):1527-33.
Referans6. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982;6 (1):3-9.
Referans7. Hikspoors JPJM, Peeters MMJP, Kruepunga N, Mekonen HK, Mommen GMC, Köhler SE et al. Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry. Sci Rep. 2017;7(1):17109.
Referans8. Couinaud, C. (Masson, Paris, 1957).
Referans9. HEALEY JE Jr, SCHROY PC. Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts. AMA Arch Surg. 1953;66(5): 599-616.
Referans10. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5): 351-55.
Referans11. Dohke M, Watanabe Y, Okumura A, Amoh Y, Oda K, Ishimori T, Koike S, Hayashi T, Hiyama A, Dodo Y. Anomalies and anatomic variants of the biliary tree revealed by MR cholangiopancreatography. AJR Am J Roentgenol 1999; 173:1251-54.
Referans12. Düşünceli E, Erden A, Erden I. Biliyer sistemin anatomik varyasyonları: MRKP bulguları. Tanısal ve Girişimsel Radyoloji 2004;10:296-03.
Referans13. Huang TL, Cheng YF, Chen CL, Chen TY, Lee TY. Variants of the bile ducts: clinical application in the potential donor of living-related hepatic transplantation. Transplant Proc 1996; 28:1669-70.
Referans14. Wietzke-Braun P, Braun F, Müller D, Lorf T, Ringe B, Ramadori G. Adult-to-adult right lobe living donor liver transplantation: Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy. World J Gastroenterol 2006; 12:5820–25.
Referans15. Karakas HM, Celik T, Alicioglu B. Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited. Surg Radiol Anat 2008; 30:539–45
Referans16. Taghavi SA, Niknam R, Alavi SE, Ejtehadi F, Sivandzadeh GR, Eshraghian A. Anatomical Variations of the Biliary Tree Found with Endoscopic Retrograde Cholagiopancreatograhy in a Referral Center in Southern Iran. Middle East J Dig Dis 2017; 9:201-5.
Referans17. Deka P, Islam M, Jindal D, Kumar N, Arora A, Negi SS. An analysis of biliary anatomy according to different classification systems. Indian J Gastroenterol 2014; 33: 23‐ 30.