胆道镜在胆源性胰腺炎术后残余结石检测中的作用：仍有价值吗？一项回顾性研究。
Role of intraoperative cholangiography for detecting residual stones after biliary pancreatitis: still useful? A retrospective study.
机构信息
Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar.
Department of Surgery, Barone Romeo Hospital, via Mazzini 14, 98066 Patti, (ME) Italy.
出版信息
World J Emerg Surg. 2017 Apr 20;12:18. doi: 10.1186/s13017-017-0130-9. eCollection 2017.
BACKGROUND
Intraoperative cholangiography (IOC) may detect residual stones in the common bile duct (CBD) after acute biliary pancreatitis (ABP). The aim of the present study is to analyze the utility of IOC in detecting residual stones in patients undergoing cholecystectomy for ABP and if complications are related with this procedure.
METHODS
Demographic and clinical factors were assessed in patients with mild ABP who underwent IOC during laparoscopic cholecystectomy. Factors assessed included preoperative size of the CBD on ultrasonography, presence of stones in the gallbladder and the CBD, and IOC results. For the statistical analysis, or Fisher's exact tests to compare proportions and the nonparametric Mann-Whitney test for analysis of values with abnormal distribution were used.
RESULTS
The study included 113 patients, 82 males (72.6%) and 31 females (27.4%), of mean age 46.9 14.7 years (range 18-86 years). All preoperative laboratory indicators were elevated. The group of the patients with stones in the CBD diagnosed by IOC was divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD diagnosed preoperatively with ultrasound. The laboratory tests do not demonstrate difference statistically significative between these two groups. The group of the patients without stones in the CBD diagnosed by IOC was also divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD. Also in these two groups, the statistical analysis of the laboratory tests does not demonstrate significative difference. Most procedures were performed by specialists (64.6%), and all patients underwent IOC. IOC showed stones in 84/113 patients (74.3%). A comparison of patients with and without stones at IOC showed similar mean times from hospitalization to surgery (5.9 days [range 2-12 days] vs. 6.1 days [range 2-23 days]), from surgery until hospital discharge (2.0 days [range 0-4 days] vs. 2.2 days [range 0-11 days]), and overall length of stay (7.9 days [range 3-19 days] vs. 8.3 days [range 3-23 days]) ( > 0.001).
CONCLUSIONS
IOC is useful to diagnose residual CBD stones, without increasing complications related to the procedure itself.
背景
急性胆源性胰腺炎（ABP）后，术中胆管造影（IOC）可能会检测到胆总管（CBD）中的残余结石。本研究旨在分析 IOC 在检测行腹腔镜胆囊切除术的 ABP 患者中残余结石的效用，如果存在并发症，其是否与该手术有关。
方法
在接受腹腔镜胆囊切除术的轻度 ABP 患者中，评估 IOC 期间的人口统计学和临床因素。评估的因素包括术前超声检查 CBD 的大小、胆囊和 CBD 中的结石以及 IOC 结果。对于统计分析，使用 或 Fisher 确切检验比较比例，使用非参数 Mann-Whitney 检验分析具有异常分布的数值。
结果
研究纳入 113 例患者，其中男性 82 例（72.6%），女性 31 例（27.4%），平均年龄 46.9±14.7 岁（范围 18-86 岁）。所有术前实验室指标均升高。IOC 诊断 CBD 有结石的患者组，分为 CBD 术前超声诊断直径<0.8mm 和直径≥0.8mm 的患者组。两组患者的实验室检查无统计学差异。IOC 诊断 CBD 无结石的患者组，也分为 CBD 术前超声诊断直径<0.8mm 和直径≥0.8mm 的患者组。在这两组中，实验室检查的统计分析也没有显示出有统计学意义的差异。大多数手术都是由专家完成（64.6%），所有患者均进行了 IOC 检查。IOC 在 113 例患者中有 84 例（74.3%）显示有结石。IOC 有结石与无结石的患者比较，住院至手术的平均时间（5.9 天[范围 2-12 天]与 6.1 天[范围 2-23 天]）、手术至出院的平均时间（2.0 天[范围 0-4 天]与 2.2 天[范围 0-11 天]）以及总住院时间（7.9 天[范围 3-19 天]与 8.3 天[范围 3-23 天]）相似（ > 0.001）。
结论
IOC 有助于诊断 CBD 残余结石，且不会增加与该手术本身相关的并发症。
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