胆囊切除术的并发症：腹腔镜手术方法的风险及术中胆管造影的保护作用：一项基于人群的研究
Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.
作者信息
Fletcher D R, Hobbs M S, Tan P, Valinsky L J, Hockey R L, Pikora T J, Knuiman M W, Sheiner H J, Edis A
机构信息
Department of Surgery, University of Western Australia and Fremantle Hospital, Australia.
出版信息
Ann Surg. 1999 Apr;229(4):449-57. doi: 10.1097/00000658-199904000-00001.
BACKGROUND
Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystectomy (OC). Population-based studies are required to estimate the magnitude of the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced.
METHODS
Suspected cases of intraoperative injury associated with cholecystectomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons undergoing postoperative endoscopic retrograde cholangiopancreatography. The case records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factors.
RESULTS
After the introduction of LC in 1991, the proportion of all cholecystectomy cases with intraoperative injury increased from 0.67% in 1988-90 to 1.33% in 1993-94. Similar relative increases were observed in bile duct injuries, major bile leaks, and other injuries to bowel or vascular structures. Increases in intraoperative injury were observed in both LC and OC. After adjustment for age, gender, hospital type, severity of disease, intraoperative cholangiography, and calendar period, the odds ratio for intraoperative injury in LC compared with OC was 1.79. Operative cholangiography significantly reduced the risk of injury.
CONCLUSION
Operative cholangiography has a protective effect for complications of cholecystectomy. Compared with OC, LC carries a nearly twofold higher risk of major bile, vascular, and bowel complications. Further study is required to determine the extent to which potentially preventable factors contribute to this risk.
背景
先前的研究表明，与开腹胆囊切除术（OC）相比，腹腔镜胆囊切除术（LC）术中涉及胆管、肠道和血管结构损伤的风险增加。需要基于人群的研究来估计风险增加的程度，确定其是否随时间变化，并找出可能降低这种风险的方法。
方法
从常规收集的医院统计记录和接受术后内镜逆行胰胆管造影术的人员名单中，识别出1988年至1994年西澳大利亚州与胆囊切除术相关的术中损伤疑似病例。对疑似病例的病历进行审查，以确认损伤的性质和部位。在调整混杂因素后，使用有序逻辑回归来估计与OC相比，LC相关的损伤风险。
结果
1991年引入LC后，所有胆囊切除术中伴有术中损伤的病例比例从1988 - 1990年的0.67%增加到1993 - 1994年的1.33%。在胆管损伤、主要胆漏以及肠道或血管结构的其他损伤方面，也观察到了类似的相对增加。LC和OC术中损伤均有增加。在调整年龄、性别、医院类型、疾病严重程度、术中胆管造影和日历时间后，与OC相比，LC术中损伤的比值比为1.79。术中胆管造影显著降低了损伤风险。
结论
术中胆管造影对胆囊切除术并发症有保护作用。与OC相比，LC发生主要胆、血管和肠道并发症的风险几乎高出两倍。需要进一步研究以确定潜在可预防因素在多大程度上导致了这种风险。
Zotero 插件