Department of Surgery, Loimaa District Hospital, Seppälänkatu 15-17, PB 17, 32201 Loimaa, Finland.
Surg Endosc. 2011 Sep;25(9):2906-10. doi: 10.1007/s00464-011-1641-1. Epub 2011 Mar 24.
After the introduction of laparoscopic cholecystectomy (LC), scientific discussion and concern about iatrogenic bile duct injuries (BDIs) have been limited mostly to BDIs sustained in LC, while BDIs sustained in open cholecystectomy (OC) and in all cholecystectomies have not been the center of attention.
This study included all patients who sustained BDI in OC or LC in southwest Finland between 1997 and 2007. All data were collected retrospectively in June 2009.
Altogether 75 BDIs were encountered in a total of 8349 cholecystectomies, for an overall incidence of 0.90%. Twenty BDIs (15 Amsterdam type A and 5 type B, C, or D) occurred in the 1616 OCs (incidence rate = 1.24%), and 55 (26 type A and 29 type B, C, or D) in the 6733 LCs (incidence rate = 0.82%). All the BDIs in the OCs were missed while 11/29 of the major BDIs in the LCs were detected at the time of surgery. Fifty-four of 59 type A, B, and C BDIs could be treated endoscopically.
In the laparoscopic era, OC is associated with a high number of BDIs, if minor BDIs are included. Excluding some major LC BDIs, BDIs are, as a rule, missed at the time of surgery. More than 90% of Amsterdam types A, B, and C BDIs can be treated endoscopically, whereas type D BDI remains an absolute indication for surgery.
腹腔镜胆囊切除术（LC）引入后，关于医源性胆管损伤（BDI）的科学讨论和关注主要局限于 LC 中发生的 BDI，而开腹胆囊切除术（OC）和所有胆囊切除术发生的 BDI 则未受到关注。
本研究纳入了 1997 年至 2007 年间在芬兰西南部 OC 或 LC 中发生 BDI 的所有患者。所有数据均于 2009 年 6 月回顾性收集。
在总共 8349 例胆囊切除术中，共有 75 例发生 BDI，总体发生率为 0.90%。在 1616 例 OC 中发生了 20 例 BDI（15 例 Amsterdam 分型 A 型和 5 例 B、C 或 D 型），6733 例 LC 中发生了 55 例（26 例 Amsterdam 分型 A 型和 29 例 B、C 或 D 型）。OC 中的所有 BDI 均被漏诊，而 LC 中 29 例主要 BDI 中有 11 例在手术时被发现。59 例 Amsterdam 分型 A、B 和 C 型 BDI 中有 54 例可经内镜治疗。
在腹腔镜时代，如果包括小的 BDI，OC 与大量 BDI 相关。除了一些主要的 LC BDI 外，BDI 在手术时通常会被漏诊。超过 90%的 Amsterdam 分型 A、B 和 C 型 BDI 可经内镜治疗，而 D 型 BDI 仍为手术的绝对适应证。
