Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
Br J Surg. 2014 May;101(6):677-84. doi: 10.1002/bjs.9486. Epub 2014 Mar 24.
The role of intraoperative cholangiography (IOC) in the diagnosis, prevention and management of bile duct injury (BDI) remains controversial. The aim of the present study was to determine the value of routine IOC in the diagnosis and management of BDI sustained during laparoscopic cholecystectomy (LC) at a high-volume centre.
A retrospective analysis of a single-institution database was performed. Patients who underwent LC with routine IOC between October 1991 and May 2012 were included.
Among 11,423 consecutive LCs IOC was performed successfully in 95.7 per cent of patients. No patient had IOC-related complications. Twenty patients (0.17 per cent) sustained a BDI during LC, and the diagnosis was made during surgery in 18 patients. Most BDIs were type D according to the Strasberg classification. The sensitivity of IOC for the detection of BDI was 79 per cent; specificity was 100 per cent. All injuries diagnosed during surgery were repaired during the same surgical procedure. Two patients developed early biliary strictures that were treated by percutaneous dilatation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results.
The routine use of IOC during LC in a high-volume teaching centre was associated with a low incidence of BDI, and facilitated detection and repair during the same surgical procedure with a good outcome.
术中胆管造影（IOC）在胆管损伤（BDI）的诊断、预防和处理中的作用仍存在争议。本研究旨在确定在高容量中心行腹腔镜胆囊切除术（LC）时常规使用 IOC 对 BDI 的诊断和处理的价值。
对单一机构数据库进行回顾性分析。纳入 1991 年 10 月至 2012 年 5 月期间行 LC 并常规行 IOC 的患者。
在 11423 例连续 LC 中，95.7%的患者成功进行了 IOC。无患者发生 IOC 相关并发症。20 例（0.17%）在 LC 期间发生 BDI，18 例在术中诊断。根据 Strasberg 分类，大多数 BDI 为 D 型。IOC 对 BDI 的检出率为 79%，特异性为 100%。术中诊断的所有损伤均在同一手术过程中进行修复。2 例患者发生早期胆管狭窄，经皮扩张和 Roux-en-Y 肝肠吻合术治疗，长期结果满意。
在高容量教学中心行 LC 时常规使用 IOC，BDI 发生率低，有助于在同一手术过程中发现和修复，且预后良好。
