Department of Surgery, University of California, San Francisco, East Bay, Oakland, CA 94602, USA.
Am J Surg. 2012 Apr;203(4):480-7. doi: 10.1016/j.amjsurg.2011.08.018. Epub 2012 Feb 9.
Two decades since the advent of laparoscopic cholecystectomy, the rate of bile duct injuries still remains higher than in the open cholecystectomy era.
The rate and complexity of bile duct injuries was evaluated in 83,449 patients who underwent laparoscopic cholecystectomy between 1995 and 2008 in the Kaiser Permanente Northern California system. Fifty-six surgeons who performed a laparoscopic cholecystectomy in the past were surveyed to determine factors that predispose to bile duct injuries.
The overall incidence of bile duct injuries was .10%; 59.5% of the 84 injuries were cystic duct leaks. Incidence varied slightly from .10% (1995-1998) to .08% (1999-2003) and .12% (2004-2008). There was a trend toward more proximal injuries (injury <2 cm from the bifurcation: 14.3% to 44.4% to 50.0% of major injuries). The misinterpretation of anatomy was cited by 92.9% of surgeons as the primary cause of bile duct injuries; 70.9% cited a lack of experience as a contributing factor.
Laparoscopic cholecystectomy has an overall low risk of bile duct injuries; the rate remains constant, but injury complexity may have increased over time.
自腹腔镜胆囊切除术出现以来的二十年中，胆管损伤的发生率仍然高于开放胆囊切除术时代。
在 1995 年至 2008 年期间，在 Kaiser Permanente 北加州系统中对 83449 例接受腹腔镜胆囊切除术的患者评估了胆管损伤的发生率和复杂性。对过去进行过腹腔镜胆囊切除术的 56 名外科医生进行了调查，以确定导致胆管损伤的因素。
胆管损伤的总发生率为 0.10%；84 例损伤中有 59.5%为胆囊管漏。发生率从 1995-1998 年的 0.10%略有下降至 1999-2003 年的 0.08%和 2004-2008 年的 0.12%。近端损伤的趋势更为明显（距分叉<2cm 的损伤：主要损伤中的 14.3%至 44.4%至 50.0%）。92.9%的外科医生将解剖结构的错误解释作为胆管损伤的主要原因；70.9%的外科医生认为缺乏经验是一个促成因素。
腹腔镜胆囊切除术总体上具有较低的胆管损伤风险；发生率保持不变，但损伤复杂性可能随时间推移而增加。
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