Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy
Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy
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DOI：
10.1001/jama.289.13.1639
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发表时间：
2003-04-02
影响因子：
120.7
通讯作者：
Koepsell, T
中科院分区：
文献类型：
--
作者：
Flum, DR;Dellinger, EP;Koepsell, T
背景术中胆管造影术（IOC）可以通过帮助避免错误识别胆总管（CBD）来降低胆囊切除术期间CBD损伤的风险。目的描述IOC使用和CBD损伤的关系，同时控制患者和外科医生的特征。设计、设置和患者回顾性全国范围内对1992年1月1日开始接受胆囊切除术的医疗保险患者进行队列分析。到1999年12月31日。使用Medicare Part B寄存处的当前程序术语代码识别患者。胆总管损伤的定义是在胆囊切除术后1年内进行第二次手术修复CBD损伤。外科医生的人口统计学特征是通过将医疗保险B部分数据与美国医学会医师主文件数据库相匹配获得的。主要结果测量在胆囊切除术期间进行和不进行IOC的患者中CBD损伤的频率，控制患者水平（年龄、性别、种族和病例复杂性）和外科医生级别（外科医生的年龄、性别、种族、外科手术年份、病例顺序、在先前外科手术中使用IOC的百分比、医疗实践年数、委员会认证，结果数据库检索确定了1570361例胆囊切除术和7911例CBD损伤（0.5%）。613706例胆囊切除术中有2380例（0.39%）发生胆总管损伤，956655例胆囊切除术中有5531例（0.58%）发生胆总管损伤（未校正相对危险度为1.49; 95%可信区间为1.42-1.57）。在控制了患者水平因素和外科医生水平因素后，当不使用IOC时，损伤的风险增加（校正的相对风险为1.71; 95%置信区间为1.38-2.28）。虽然外科医生进行IOCs常规有较低的CBD损伤率比那些谁没有，这种差异消失时，IOC不used.Conclusions在这项研究中接受胆囊切除术的医疗保险患者在20世纪90年代，CBD损伤的风险显着较高时，IOC不使用。虽然IOC可能无法预防所有的CBD损伤，但这项研究表明，IOC的常规使用可能会降低CBD损伤的发生率。
Context Intraciperative cholangiography (IOC) may decrease the risk of common bile duct (CBD) injury during cholecystectomy by helping to avoid misidentification of the CBD.Objective To characterize the relationship of IOC use and CBD injury while controlling for patient and surgeon characteristics.Design, Setting, and Patients Retrospective nationwide cohort analysis of Medicare patients undergoing cholecystectomy from January 1, 1992, to December 31, 1999. Patients were identified using Current Procedural Terminology codes from the Medicare Part B depository. Common bile duct injury was defined by a second surgical procedure to repair the CBD injury within 1 year of cholecystectomy. Surgeon demographic features were obtained from matching the Medicare Part B data to the American Medical Association Physician Masterfile database.Main Outcome Measure Frequency of CBD injury in patients who did and did not have IOC performed during cholecystectomy, controlling for patient-level (age, sex, race, and case complexity) and surgeon-level (surgeon's age, sex, race, year of surgical procedure, case order, percentage of IOC use in prior surgical procedures, years in medical practice, board certification, and specialization) factors.Results The database search identified 1570361 cholecystectomies and 7911 CBD injuries (0.5%). Common bile duct injury was found in 2380 (0.39%) of 613 706 patients undergoing cholecystectomy with IOC and in 5531 (0.58%) of 956 655 patients undergoing cholecystectomy without IOC (unadjusted relative risk, 1.49; 95% confidence interval, 1.42-1.57). After controlling for patient-level factors and surgeon-level factors, the risk of injury was increased when IOC was not used (adjusted relative risk, 1.71; 95% confidence interval, 1.38-2.28). While surgeons performing IOCs routinely had a lower rate of CBD injuries than those who did not, this difference disappeared when IOC was not used.Conclusions In this study of Medicare patients undergoing cholecystectomy in the 1990s, the risk of CBD injury was significantly higher when IOC was not used. Although IOCs may not prevent all CBD injuries, this study suggests, that the routine use of IOC may decrease the rate of CBD injury.