Fédération de chirurgie viscérale et digestive (FCVD), 12, rue BAYARD, 31000, Toulouse, France.
J Gastrointest Surg. 2021 Jun;25(6):1430-1436. doi: 10.1007/s11605-020-04640-4. Epub 2020 May 14.
This study aims to assess the cost and the effectiveness of intraoperative cholangiography (IOC) for the diagnosis and treatment of a bile duct injury (BDI) after incorrect or difficult identification of the cystic duct (DICD) during a cholecystectomy.
Between 2009 and 2015, 810 surgeons reported 1161 treatment-related adverse events related to the DICD during cholecystectomy in the French REX database; 623 patients (54%) underwent IOC, and 30% (n = 348) of DICD had a BDI. The therapeutic procedures and the treatment costs have been compared between the IOC group (CG) and the group without IOC (WCG).
The BDI intraoperative diagnosis was significantly higher in the CG: 96% vs. 67% p = 0.001. The number of therapeutic procedure was significantly higher in the WCG OR: 6 (3-10.6). The rate of biliodigestive anastomosis (8.3%) was similar between the both groups. The average cost of cholecystectomy in the at-risk population of DICD was higher in the group that did not undergo IOC (6204 euros vs. 8831 euros). The estimated loss without IOC in the studied population was between 788,170 and 2,039,020 euros.
The IOC was an assurance of quality and cost reduction in the immediate management of the BDI and should be systematic in front of a DICD during a cholecystectomy.
本研究旨在评估术中胆管造影（IOC）在诊断和治疗胆囊切除术中误判或难以识别胆囊管（DICD）后胆管损伤（BDI）的成本和效果。
在 2009 年至 2015 年期间，法国 REX 数据库报告了 810 名外科医生在胆囊切除术中与 DICD 相关的 1161 例治疗相关不良事件，其中 623 名患者（54%）接受了 IOC，30%（n=348）的 DICD 发生了 BDI。比较了 IOC 组（CG）和无 IOC 组（WCG）之间的治疗程序和治疗费用。
CG 中 BDI 的术中诊断率明显更高：96% vs. 67%，p=0.001。WCG 的治疗程序数量明显更高：6（3-10.6）。两组之间胆肠吻合术（8.3%）的发生率相似。DICD 高危人群中，未行 IOC 组的胆囊切除术平均费用更高（6204 欧元 vs. 8831 欧元）。在研究人群中，如果不进行 IOC，估计损失在 788170 欧元至 2039020 欧元之间。
IOC 是 BDI 即时管理中质量和成本降低的保证，在胆囊切除术中应系统地进行 DICD。
