Gahagan John V, Maximus Steven, Whealon Matthew D, Phelan Michael J, Demirjian Aram, Joe Victor C
Department of Surgery, University of California Irvine School of Medicine, Irvine, California, USA.
Am Surg. 2016 Oct;82(10):985-988.
The necessity of routine endoscopic retrograde cholangiopancreatography (ERCP) after positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy is not well defined. We aimed to examine the incidence of positive IOC among patients who undergo IOC during cholecystectomy and the rate of subsequent ERCP stone extraction. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy with IOC from 2002 to 2012. Patients were then analyzed for ERCP and stone extraction. A total of 73,508 patients who underwent cholecystectomy with IOC for a diagnosis of acute cholecystitis and found to have a bile duct stone were identified. Of these patients, 5915 underwent subsequent ERCP. In the patients that underwent subsequent ERCP, 1478 had a documented stone extraction during ERCP. The rate of stone extraction in the ERCP subset is 25 per cent, which is 2 per cent of all patients who had a positive IOC. The rate of stone extraction after positive IOC is low. Positive IOC may not warrant a routine postoperative ERCP. Our results suggest that clinical monitoring of patients with positive IOC is reasonable, as the majority of patients with a positive IOC ultimately have no stone extraction.
腹腔镜胆囊切除术期间术中胆管造影（IOC）阳性后进行常规内镜逆行胰胆管造影（ERCP）的必要性尚未明确界定。我们旨在研究胆囊切除术期间接受IOC检查的患者中IOC阳性的发生率以及随后进行ERCP取石的比率。对2002年至2012年期间所有接受胆囊切除术并进行IOC检查的患者的全国住院患者样本数据库进行了回顾。然后对患者进行ERCP和取石分析。总共确定了73508例因诊断为急性胆囊炎而接受胆囊切除术并进行IOC检查且发现有胆管结石的患者。在这些患者中，5915例随后接受了ERCP。在随后接受ERCP的患者中，1478例在ERCP期间有记录的取石操作。ERCP亚组中的取石率为25%，占所有IOC阳性患者的2%。IOC阳性后的取石率较低。IOC阳性可能不需要常规的术后ERCP。我们的结果表明，对IOC阳性患者进行临床监测是合理的，因为大多数IOC阳性患者最终未进行取石操作。
