Avgerinos C, Kelgiorgi D, Touloumis Z, Baltatzi L, Dervenis C
1st Surgical Department, Agia Olga Hospital, 3-5 Agias Olgas Str, Athens 14233, Greece.
J Gastrointest Surg. 2009 Mar;13(3):498-503. doi: 10.1007/s11605-008-0748-8. Epub 2008 Nov 14.
Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). They are accompanied by major morbidity, occasional mortality, lengthening of hospital stay, additional health costs, and deterioration of patients' quality of life and life expectancy. The aim of this study was to present the method of "critical view of safety" (CVS) as safe and feasible for the prevention of bile duct injuries during laparoscopic cholecystectomy.
During a 6-year period from January 2002 till December 2007, 1,046 LCs (369 men and 677 women) were performed mainly for symptomatic gallstone disease. The CVS technique recommends clearing the triangle of Calot of fat and fibrous tissue and taking the gallbladder off the lowest part of its attachment to the gallbladder bed. The "infundibular" technique (identification of cystic duct and gallbladder junction) was used whenever CVS was not possible to perform.
The CVS was performed in 998 patients (95.4%). Overall, 27 patients needed conversion to the open approach (2.6%). This rate was higher in patients with acute inflammation undergoing early operation (nine of 128, 7%) compared with patients operated later or electively (18 of 914, 1.9%). There was no bile duct injury in the 1,046 cholecystectomies. Postoperatively, five patients had bile leaks which were transient and stopped spontaneously after 2-14 days. Two reoperations were performed because of severe bleeding.
CVS clarifies the relations of the anatomic structures that should be divided, and therefore, it should be ideally and routinely applied in all LCs because of its highly protective role against bile duct injuries.
自腹腔镜胆囊切除术（LC）开展以来，胆管损伤显著增加。这些损伤伴随着严重的发病率、偶发的死亡率、住院时间延长、额外的医疗费用以及患者生活质量和预期寿命的下降。本研究的目的是介绍“安全关键视野”（CVS）方法，该方法对于预防腹腔镜胆囊切除术中的胆管损伤是安全可行的。
在2002年1月至2007年12月的6年期间，主要因有症状的胆结石疾病进行了1046例LC手术（369例男性和677例女性）。CVS技术建议清除胆囊三角区的脂肪和纤维组织，并从胆囊与胆囊床附着的最低部位切除胆囊。每当无法进行CVS时，使用“漏斗状”技术（识别胆囊管与胆囊的交界处）。
998例患者（95.4%）采用了CVS。总体而言，27例患者需要转为开放手术（2.6%）。与后期或择期手术的患者（914例中的18例，1.9%）相比，早期进行手术的急性炎症患者（128例中的9例，7%）这一比例更高。1046例胆囊切除术中无胆管损伤。术后，5例患者出现胆汁渗漏，渗漏是短暂的，在2 - 14天后自行停止。因严重出血进行了2次再次手术。
CVS明确了应分离的解剖结构之间的关系，因此，由于其对胆管损伤具有高度保护作用，应理想地且常规地应用于所有LC手术中。
