Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography - Adverse outcome or preventable error?
Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography - Adverse outcome or preventable error?
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DOI：
10.1001/archsurg.136.11.1287
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发表时间：
2001-11-01
影响因子：
--
通讯作者：
Dellinger, EP
中科院分区：
文献类型：
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作者：
Flum, DR;Koepsell, T;Dellinger, EP
背景：胆总管损伤是腹腔镜胆囊切除术（I-C）的严重并发症。这种不良结果的预测因素还没有很好的文献记载。假设：外科医生经验和术中胆道造影（IOC）的使用与LC期间主要CBD损伤率的降低有关。设计：以人群为基础的回顾性队列研究背景：1991年至1998年华盛顿州医院出院数据库报告。患者：在出院报告中检索国际疾病分类第九版，与LC一致的程序代码，然后在LC后90天内评估CBD修复和重建的程序代码。主要结局指标：基于外科医生经验和IOC使用的LC患者的CBD损伤率。结果：本分析共发现30630例lccs和76例主要CBD损伤（2.5/1000例手术）。受伤和非受伤患者在人口统计学、疾病、付款人状况或医院变量方面没有显著差异。在外科医生的早期病例序列中，每1000例lccs中有3.2例发生CBD损伤，而在后期，每1000例lccs中有1.7例发生CBD损伤（P = 0.01）（相对风险，1.81；95%可信区间，1.44-2.88）。未进行IOC的肝细胞损伤率为3.3 / 1000，而有IOC的肝细胞损伤率为2.0 / 1000 (P = 0.02)（相对危险度为1.7；95%可信区间为1.1-2.6）。外科医生的经验和IOC的使用是损伤的独立预测因素。结论：使用TOC可显著降低CBD损伤率。这种影响在外科医生的早期经历中被放大了。系统使用IOC可显著降低CBD损伤率。
Background: Common bile duct (CBD) injury is a serious complication of laparoscopic cholecystectomy (I-C). Predictors of this adverse outcome have not been well documented.Hypothesis: Surgeon experience and the use of intraoperative cholangiography (IOC) are associated with a decreased rate of major CBD injury during LC.Design: A retrospective population-based cohort studySetting: Washington State hospital discharge database reports from 1991 through 1998.Patients: Discharge reports were searched for international Classification of Diseases, Ninth Revision, procedure codes consistent with LC and then evaluated for procedure codes for CBD repair and reconstruction within 90 days of LC.Main Outcome Measure: The rate of CBD injury in patients undergoing LC based on the surgeon's experience and IOC use.Results: In all, 30630 LCs and 76 major CBD injuries (2.5/1000 operations) were identified in this analysis. There were no significant differences between injured and noninjured patients in demographics, disease, payer status, or hospital variables. A CBD injury occur-red in 3.2 of 1000 LCs in the early case order of surgeons compared with 1.7 per 1000 at later points (P = .01) (relative risk, 1.81; 95% confidence interval, 1.44-2.88). The rate of injury in LCs performed without IOC was 3.3 per 1000 compared with 2.0 per 1000 in LCs with IOC (P = .02) (relative risk, 1.7; 95% confidence interval, 1.1-2.6). Surgeon's experience and IOC use were independent predictors of injury.Conclusions: The rate of CBD injury is significantly lower when TOC is used. This effect is magnified during the early experience of surgeons. Systematic use of IOC may Significantly reduce the rate of CBD injury.