[视频腹腔镜胆囊切除术中的术中胆管造影。其作用是什么？一项非随机研究的结果]
[The intraoperative cholangiography during videolaparoscopic cholecystectomy. What is its role? Results of a non randomized study].
作者信息
Ciulla Antonio, Agnello Giuseppe, Tomasello Giovanni, Castronovo Gioacchino, Maiorana Alfonso Maurizio, Genova Gaspare
机构信息
Università degli studi di Palermo, Dipartimento di Chirurgia generale, Urgenza e Trapianti d'organo.
出版信息
Ann Ital Chir. 2007 Mar-Apr;78(2):85-9.
INTRODUCTION
The routine use of intraoperative cholangiography during laparoscopic cholecystectomy remains controversial. Mirizzi was the first to recommend the use of intraoperative cholangiography in 1931 based on the high incidence of unsuspected common bile duct stones. The use of intraoperative cholangiography before common bile duct exploration reduced the incidence of unnecessary common bile duct explorations from 66% to less than 5%. With the introduction of laparoscopic cholecystectomy, an increase of incidence of bile duct injury two to four times that seen in open cholecystectomy was witnessed. The vast majority of the injuries were a direct result of the surgeon misidentifying the anatomy. The Authors report their experience in the use of intraoperative cholangiography to prevent bile duct injuries and to discover common bile duct unknown lithiasis.
METHODS
From December 2002 to January 2004 in 169 patients affected to cholecystolithiasis were undergone cholecystectomy. During this operation intraoperative cholangiography was performed routinely. The patients were divided in two groups. In the Group A the patient with high risk according to a score system. and the others in the group B.
RESULTS
The cholangiography was performed with success in the 97% of patients. It were discover common bile duct in the 17%, biliary anatomy anomalies in the 3.5%, bile duct injuries in the 0.5% and false positive in the 2.9%.
CONCLUSION
The Authors recommended the routinely use of intraoperative cholangiography owing to its a feasible and safe technique with a success rater greater than 90%. If a bile duct injury is going to occur because of misidentification, cholangiography will not prevent the injury, but a properly performed cholangiogram will minimize the extent of the injury. Finally, the intraoperative cholangiography can discover a common unknown bile duct lithiasis and can reduce incidence of unnecessary ERCP with subsequent complication
引言
腹腔镜胆囊切除术中常规使用术中胆管造影仍存在争议。1931年，米里齐首次建议使用术中胆管造影，因为未被怀疑的胆总管结石发病率很高。在胆总管探查前使用术中胆管造影将不必要的胆总管探查发生率从66%降低至不到5%。随着腹腔镜胆囊切除术的引入，胆管损伤的发生率增加到开放胆囊切除术的两到四倍。绝大多数损伤是外科医生误认解剖结构的直接结果。作者报告了他们使用术中胆管造影预防胆管损伤和发现胆总管隐匿性结石的经验。
方法
2002年12月至2004年1月，对169例胆囊结石患者进行了胆囊切除术。在此手术过程中常规进行术中胆管造影。患者分为两组。A组为根据评分系统属于高危的患者，其他患者归入B组。
结果
97%的患者成功进行了胆管造影。发现胆总管结石的患者占17%，胆管解剖异常的患者占3.5%，胆管损伤的患者占0.5%，假阳性的患者占2.9%。
结论
作者建议常规使用术中胆管造影，因为它是一种可行且安全的技术，成功率超过90%。如果因误认而即将发生胆管损伤，胆管造影无法预防损伤，但正确进行的胆管造影将使损伤程度降至最低。最后，术中胆管造影可以发现胆总管隐匿性结石，并可降低不必要的内镜逆行胰胆管造影及其后续并发症的发生率
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