Wysocki Arkadiusz P, Murphy Skyle, Ware Robert S
Department of Surgery, Logan Hospital, Logan City, Queensland, Australia.
Griffith University Medical School, Griffith Health Centre, Logan City, Queensland, Australia.
ANZ J Surg. 2018 Jun;88(6):630-634. doi: 10.1111/ans.14087. Epub 2017 Jul 1.
In order to minimize bile duct injury, experts suggest that dissection during laparoscopic cholecystectomy (LC) should be performed lateral to the lymph node (LN). This study aims to determine whether the frequency of excision of the LN is related to patient factors, disease severity or surgical difficulty.
All LCs performed or supervised by one surgeon were identified from a prospective database. The presence of LN was retrospectively determined by reviewing the gallbladder histology report.
The LN was identified in 10.4% of 1332 cholecystectomies. The American Society of Anesthesiologists class 3 was associated with a lower rate of LN excision compared with class 1 (odds ratio: 0.36; P = 0.049) as was the presence of a senior surgical trainee (odds ratio: 0.18; P < 0.001). Rate of LN excision was independent of patient demographic and clinical characteristics, including indication for cholecystectomy, conversion to open, gallbladder perforation, cholangiography, bile duct exploration and overall surgical difficulty.
The frequency with which the LN is excised during LC by the one surgeon is independent of the majority of clinical and surgical factors and may represent a surrogate marker of surgical technique. Whether this is related to the rate of bile duct injury remains to be determined.
为了将胆管损伤降至最低，专家建议在腹腔镜胆囊切除术（LC）中应在淋巴结（LN）外侧进行解剖。本研究旨在确定LN切除频率是否与患者因素、疾病严重程度或手术难度相关。
从一个前瞻性数据库中识别出由一名外科医生实施或监督的所有LC手术。通过回顾胆囊组织学报告，回顾性确定LN的存在情况。
在1332例胆囊切除术中，10.4%发现有LN。与1级相比，美国麻醉医师协会3级与较低的LN切除率相关（优势比：0.36；P = 0.049），高级外科实习生的存在也与之相关（优势比：0.18；P < 0.001）。LN切除率与患者人口统计学和临床特征无关，包括胆囊切除术的指征、转为开腹手术、胆囊穿孔、胆管造影、胆管探查和总体手术难度。
该外科医生在LC中切除LN的频率与大多数临床和手术因素无关，可能代表手术技术的一个替代指标。这是否与胆管损伤率相关仍有待确定。
