Fogli Luciano, Boschi Sergio, Patrizi Patrizio, Berta Rossana Daniela, Al Sahlani Ubaid, Capizzi Daniele, Capizzi Francesco Domenico
Department of Digestive and Laparoscopic Surgery, Maggiore Hospital, Bologna, Italy.
J Laparoendosc Adv Surg Tech A. 2009 Apr;19(2):191-3. doi: 10.1089/lap.2008.0268.
There is no uniform consensus on the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC). In this paper, we present a 10-year retrospective audit of our cases of LC without IOC, performed by a search of readmission cases through our electronic database. Data regarding all patients subjected to LC at our unit in the period January 1996-December 2006 were obtained through our hospital database system. Subsequently, a query was made to ascertain if there were any readmissions to any of our city hospitals, up to December 2006. A total of 1321 patients underwent LC at our unit in the period January 1, 1996-December 31, 2006. The median operating time for LC without IOC was 58 minutes (range, 15-370). The median hospital stay was 2 days (range, 1-30). Postoperative outcome was uneventful in 1250 patients (94.7%). There was no mortality. Grade I and II complications occurred in the remaining 71 patients. Patients were stratified by risk of common bile duct stones (BDSs) according to clinical, ultrasonographic, and serum chemistry data. Patients with suspected BDS underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and BDS clearance (142 patients). No patient in our series of LC was readmitted to any of the city hospitals for biliary desease up to 10 years after the operation. Our retrospective audit confirms the safety of LC without routine IOC and the rarity of readmissions for retained BDS and supports the policy of selective IOC.
对于腹腔镜胆囊切除术（LC）期间常规术中胆管造影（IOC）的效用，目前尚无统一共识。在本文中，我们通过电子数据库搜索再入院病例，对我们开展的无IOC的LC病例进行了为期10年的回顾性审计。通过我们医院的数据库系统获取了1996年1月至2006年12月期间在我们科室接受LC的所有患者的数据。随后，进行查询以确定截至2006年12月是否有患者再次入住我们市内的任何一家医院。1996年1月1日至2006年12月31日期间，共有1321例患者在我们科室接受了LC。无IOC的LC的中位手术时间为58分钟（范围为15 - 370分钟）。中位住院时间为2天（范围为1 - 30天）。1250例患者（94.7%）术后恢复顺利。无死亡病例。其余71例患者发生了I级和II级并发症。根据临床、超声和血清化学数据，将患者按胆总管结石（BDS）风险进行分层。疑似BDS的患者接受了术前内镜逆行胰胆管造影（ERCP）及BDS清除术（142例患者）。在我们的LC系列病例中，直至术后10年，没有患者因胆道疾病再次入住市内的任何一家医院。我们的回顾性审计证实了无常规IOC的LC的安全性以及因残留BDS再次入院的罕见性，并支持选择性IOC策略。
