Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury
Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury
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DOI：
10.1002/bjs.9486
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发表时间：
2014-05-01
影响因子：
9.6
通讯作者：
Pekolj, J.
中科院分区：
文献类型：
--
作者：
Alvarez, F. A.;de Santibanes, M.;Pekolj, J.
背景资料：术中胆管造影（IOC）在诊断、预防和处理胆管损伤（BDI）中的作用仍存在争议。本研究的目的是确定常规IOC的诊断和管理的BDI持续在腹腔镜胆囊切除术（LC）在高容量centre.Methods的价值：一个单一的机构数据库进行回顾性分析。1991年10月至2012年5月期间接受LC常规IOC的患者包括在内。结果：在11423例连续LC中，95.7%的患者成功完成IOC。无患者发生IOC相关并发症。20例患者（0.17%）在LC期间持续BDI，18例患者在手术期间诊断。根据Strasberg分类，大多数BDI为D型。IOC检测BDI的灵敏度为79%;特异性为100%。手术期间诊断的所有损伤均在同一手术过程中得到修复。两名患者开发的早期胆管狭窄，经皮扩张和Roux-en-Y hepaticojejunostomy治疗，具有令人满意的长期result.Conclusion：常规使用IOC在LC在高容量的教学中心与BDI的发病率低，并促进检测和修复在同一手术过程中具有良好的效果。
Background: The role of intraoperative cholangiography (IOC) in the diagnosis, prevention and management of bile duct injury (BDI) remains controversial. The aim of the present study was to determine the value of routine IOC in the diagnosis and management of BDI sustained during laparoscopic cholecystectomy (LC) at a high-volume centre.Methods: A retrospective analysis of a single-institution database was performed. Patients who underwent LC with routine IOC between October 1991 and May 2012 were included.Results: Among 11 423 consecutive LCs IOC was performed successfully in 95.7 per cent of patients. No patient had IOC-related complications. Twenty patients (0.17 per cent) sustained a BDI during LC, and the diagnosis was made during surgery in 18 patients. Most BDIs were type D according to the Strasberg classification. The sensitivity of IOC for the detection of BDI was 79 per cent; specificity was 100 per cent. All injuries diagnosed during surgery were repaired during the same surgical procedure. Two patients developed early biliary strictures that were treated by percutaneous dilatation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results.Conclusion: The routine use of IOC during LC in a high-volume teaching centre was associated with a low incidence of BDI, and facilitated detection and repair during the same surgical procedure with a good outcome.