Singh Kuldip, Singh Ranbir, Kaur Manjot
Department of General Surgery, Adesh Institute of Medical Science and Research, Bathinda, Punjab, India.
J Minim Access Surg. 2017 Oct-Dec;13(4):273-279. doi: 10.4103/jmas.JMAS_268_16.
Laparoscopic cholecystectomy (LC) has many advantages as compared to open cholecystectomy. However, vasculobiliary injuries still continue to be a matter of concern despite advances in laparoscopic techniques. Misidentification and misperception of vasculobiliary structures is considered to be a pivotal factor leading to injuries. Although many studies since time immemorial have stressed on the importance of anatomy, an insight into laparoscopic anatomy is what essentially constitutes the need of the hour.
To assess the frequency and the relevance of anatomical variations of extrahepatic biliary system in patients undergoing LC.
The present study is an observational study performed for a period of 2 years from August 2014 to August 2016. It included all diagnosed patients of cholelithiasis undergoing routine LC performed by a single surgeon by achieving a critical view of safety. During dissection, vascular and ductal anomalies were noted and assessed for their relevance in LC.
Seven hundred forty cases of cholelithiasis, irrespective of pathology, comprising 280 (37.83%) men and 460 (62.16%) females with a mean age of 39.85 ± 18.82 years were included in the study. Photodocumentation and operative recordings were available in 93% of cases. Operative findings revealed 197 (26.62%) vascular anomalies and 90 (12.16%) ductal anomalies. A single cystic artery was seen in 340 cases, and a normal cystic duct was seen in 650 cases. Variations in ductal anatomy were fewer than variations in vascular anatomy.
Extra-biliary anatomy relevant to LC is unpredictable and varies from patient to patient. Vascular anomalies are more frequent than the ductal anomalies, and surgeon should be alert regarding their presence.
与开腹胆囊切除术相比，腹腔镜胆囊切除术（LC）有诸多优势。然而，尽管腹腔镜技术有所进步，但血管胆管损伤仍是令人担忧的问题。血管胆管结构的错误识别和误判被认为是导致损伤的关键因素。尽管自古以来许多研究都强调了解剖学的重要性，但深入了解腹腔镜解剖学才是当前的迫切需求。
评估接受LC的患者肝外胆管系统解剖变异的频率及相关性。
本研究为一项观察性研究，时间跨度为2014年8月至2016年8月，为期2年。研究纳入了所有经诊断为胆石症且由单一外科医生进行常规LC的患者，手术中需获得安全的关键视野。在解剖过程中，记录血管和导管异常情况，并评估其在LC中的相关性。
本研究共纳入740例胆石症患者，无论病理情况如何，其中男性280例（37.83%），女性460例（62.16%），平均年龄为39.85±18.82岁。93%的病例有照片记录和手术记录。手术结果显示，有197例（26.62%）血管异常和90例（12.16%）导管异常。340例可见单一胆囊动脉，650例可见正常胆囊管。导管解剖变异少于血管解剖变异。
与LC相关的肝外解剖情况不可预测，且因人而异。血管异常比导管异常更常见，外科医生应警惕其存在。
