腹腔镜胆囊切除术中安全性与胆管损伤的批判性观点：一项对1532例患者的影像学评估研究
The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients.
作者信息
Terho Petra, Sallinen Ville, Lampela Hanna, Harju Jukka, Koskenvuo Laura, Mentula Panu
机构信息
Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland.
Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland; Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Finland.
出版信息
HPB (Oxford). 2021 Dec;23(12):1824-1829. doi: 10.1016/j.hpb.2021.04.017. Epub 2021 Apr 27.
BACKGROUND
Laparoscopic cholecystectomy (LCC) carries a 0.3-1.8% risk of bile duct injury (BDI). This study investigated if intraoperative photo documentation of the critical view of safety (CVS) is related to lower rates of BDIs and postoperative complications in LCC.
METHODS
Surgeons were instructed to take photos of the view before clipping the cystic duct and artery. Two independent raters scored the photos 0-6 using predefined criteria for CVS. Mean scores of ≥4.5 were satisfactory.
RESULTS
The study consisted of 1532 patients undergoing LCC between April 2018 and October 2019. CVS was satisfactory in 354 (23.1%), unsatisfactory in 823 (53.7%), and photos were missing in 355 (23.2%) patients. Patients with satisfactory CVS had the lowest BDI rate compared with unsatisfactory CVS or missing photos (0.3% vs. 1.0% vs. 2.3%, p = 0.012). Four major BDIs (Strasberg D-E) occurred, but none in patients with satisfactory CVS. Patients with satisfactory CVS had the lowest postoperative complication rate compared with patients with unsatisfactory CVS or without photos (4.8% vs. 7.9 vs. 9.9%, p = 0.011). Of patients with acute cholecystitis, 15.7% had satisfactory CVS, whereas 26.8% without cholecystitis had satisfactory CVS (p < 0.001).
CONCLUSION
Intraoperative photo documentation of satisfactory CVS is associated with lower rates of BDIs and complications.
背景
腹腔镜胆囊切除术（LCC）导致胆管损伤（BDI）的风险为0.3%-1.8%。本研究调查了术中对安全关键视野（CVS）进行照片记录是否与LCC中较低的BDI发生率和术后并发症相关。
方法
指导外科医生在夹闭胆囊管和动脉之前拍摄视野照片。两名独立的评估者使用预先定义的CVS标准对照片进行0-6分的评分。平均得分≥4.5为满意。
结果
该研究纳入了2018年4月至2019年10月期间接受LCC的1532例患者。354例（23.1%）患者的CVS满意，823例（53.7%）患者的CVS不满意，355例（23.2%）患者的照片缺失。与CVS不满意或照片缺失的患者相比，CVS满意的患者BDI发生率最低（0.3%对1.0%对2.3%，p = 0.012）。发生了4例严重BDI（Strasberg D-E型），但CVS满意的患者中无一例发生。与CVS不满意或无照片的患者相比，CVS满意的患者术后并发症发生率最低（4.8%对7.9%对9.9%，p = 0.011）。在急性胆囊炎患者中，15.7%的患者CVS满意，而无胆囊炎患者中26.8%的患者CVS满意（p < 0.001）。
结论
术中对满意的CVS进行照片记录与较低的BDI发生率和并发症相关。
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