Department of Digestive and Transplant Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
PLoS One. 2018 Jun 28;13(6):e0199147. doi: 10.1371/journal.pone.0199147. eCollection 2018.
The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease.
Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed.
Among the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%).
IOC can be successfully and safely performed in the majority of patients undergoing cholecystectomy for acute gallstone-related disease. Although its positive predictive value is suboptimal and results in a number of unnecessary postoperative common bile duct investigations, IOC accurately rules out common bile duct stones in patients with acute gallstone-related conditions.
胆囊切除术术中胆管造影（IOC）的作用存在争议。本研究旨在评估在因急性胆石症相关疾病而行胆囊切除术的患者中系统进行 IOC 的可行性、益处和风险。
在 2013 年 7 月至 2015 年 1 月期间，前瞻性随访了所有因急性胆石症相关疾病入院并接受同一医院住院治疗的患者。系统尝试进行 IOC，并分析 IOC 失败的预测因素。
在纳入的 581 例患者中，有 3 例故意未行 IOC。在 509/578 例患者（88.1%）中 IOC 成功。IOC 失败的主要预测因素为年龄、体重指数、男性和合并急性胆囊炎。32 例 IOC 怀疑胆总管结石的患者进行了 38 次不必要的术后胆总管阴性探查（32/509，6.3%）。有 1 例 IOC 相关不良事件（轻度胰腺炎，1/578，0.2%）。
在因急性胆石症相关疾病而行胆囊切除术的大多数患者中，IOC 可以成功且安全地进行。尽管其阳性预测值不理想，导致许多不必要的术后胆总管探查，但 IOC 可准确排除急性胆石症相关患者的胆总管结石。
