Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
J Am Coll Surg. 2011 Aug;213(2):267-74. doi: 10.1016/j.jamcollsurg.2011.03.004. Epub 2011 Apr 3.
Our university medical center is the only center in The Netherlands that has adopted a policy of routine intraoperative cholangiography (IOC) during cholecystectomy. This study aimed to describe the rate of bile duct injury (BDI) and management of common bile duct (CBD) stones before and after implementation of a routine IOC policy.
Medical records were reviewed of all patients undergoing cholecystectomy in the 3 years before implementation of routine IOC and 3 years after. Dissection with the goal to achieve the critical view of safety was the standard operative technique during the entire study period.
Four hundred and twenty-one patients underwent cholecystectomy with selective IOC and 435 patients with routine IOC. Groups were similar in age, sex, comorbidity, indication for surgery, and surgical approach. IOC was attempted in 5.9% in the selective IOC group and 59.8% in the routine IOC group (p < 0.001). The rate of major BDI was 1.9% in the selective IOC group and 0% in the routine IOC group (p = 0.004). The injuries consisted of 5 type B and 3 type D injuries, according to the Amsterdam classification. The rate of minor BDI did not differ substantially among the groups. More CBD stones were detected in the routine IOC group (4.8% versus 1.0%; p = 0.001) and they were managed intraoperatively more frequently (2.8% versus 0.7%; p = 0.023). There was a trend toward fewer preoperative and postoperative ERCPs and other interventions for CBD stones (19.1% versus 24.2%; p = 0.067).
Implementation of routine IOC policy was followed by fewer major BDIs and higher rates of intraoperative CBD stone management.
我们的大学医学中心是荷兰唯一一家在胆囊切除术中常规采用术中胆管造影术（IOC）的中心。本研究旨在描述在实施常规 IOC 政策前后胆囊切除术中胆管损伤（BDI）和胆总管（CBD）结石的处理情况。
回顾了在实施常规 IOC 政策前 3 年和后 3 年期间行胆囊切除术的所有患者的病历。在整个研究期间，以达到安全关键视图为目标的解剖是标准手术技术。
421 例患者行选择性 IOC 胆囊切除术，435 例行常规 IOC 胆囊切除术。两组患者在年龄、性别、合并症、手术指征和手术方式方面相似。选择性 IOC 组中有 5.9%尝试进行 IOC，而常规 IOC 组中有 59.8%尝试进行 IOC（p < 0.001）。选择性 IOC 组中主要 BDI 的发生率为 1.9%，而常规 IOC 组为 0%（p = 0.004）。根据阿姆斯特丹分类，损伤包括 5 型 B 和 3 型 D 损伤。各组 minor BDI 的发生率差异不大。常规 IOC 组中检测到更多的 CBD 结石（4.8%对 1.0%；p = 0.001），并且更频繁地在术中处理（2.8%对 0.7%；p = 0.023）。术前和术后 ERCP 及其他 CBD 结石干预的次数呈减少趋势（19.1%对 24.2%；p = 0.067）。
实施常规 IOC 政策后，主要 BDI 的发生率降低，CBD 结石的术中处理率升高。
