Operative Strategy Can Reduce the Incidence of Major Bile Duct Injury in Laparoscopic Cholecystectomy
Operative Strategy Can Reduce the Incidence of Major Bile Duct Injury in Laparoscopic Cholecystectomy
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手术策略可降低腹腔镜胆囊切除术中主要胆管损伤的发生率
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
J. Craig Collins
中科院分区：
文献类型：
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作者：
S. Yegiyants;J. Craig Collins
严重胆管损伤(BDI)发生率维持在0.3%至0.5%的范围内。世界上占主导地位的外科技术仍然是20世纪90年代初流行的“漏斗状”解剖技术。“安全关键观点”(CV)技术的支持者认为，这些伤害中的大多数都是可以避免的。我们研究的目的是确定常规使用心血管技术是否降低了教学医院5年内观察到的/预期的主要BDI的单一机构比率。所有在一家机构接受LC的患者(n=3042)在60个月的时间里接受了任何适应症的LC，通过数据库搜索来确定。主要的BDI是由指示手术修复的通用程序术语代码确定的，并通过回顾医疗记录来确认。1例行胆总管横切切除，行肝十二指肠吻合术。根据公布的数据，观察到的BDI比率为预期比率的九分之一至十五分之一。这表明，在大多数病例由居民执行的单一机构中，LC的安全性有了数量级的改善。我们建议应广泛采用“批判性观点”技术。
Major bile duct injury (BDI) rates remain in the range of 0.3 to 0.5 per cent for laparoscopic cholecystectomy (LC). The dominant surgical technique worldwide continues to be the “infundibular” technique of dissection that was popularized in the early 1990s. Proponents of the “critical view of safety” (CV) technique have suggested that most of these injuries are avoidable. The objective of our study was to determine whether routine use of the CV technique reduced the observed/expected single-institution rate of major BDI over a 5-year period in a teaching hospital. All patients (n = 3042) who underwent LC for any indication at one institution over a 60-month period were identified by database search. Major BDI was identified by Common Procedural Terminology codes indicating operative repair and confirmed by review of medical records. One patient sustained a transection–excision of the common duct requiring hepaticoduodenostomy. Based on published data, the observed BDI rate was one in nine to one in 15 of the expected rate. This represents an order-of-magnitude improvement in the safety of LC at a single institution where the majority of cases were performed by residents. We suggest that the “critical view” technique should be widely adopted.