Osailan Samah, Esailan Muhanad, Alraddadi Abdulaziz M, Almutairi Faisal M, Sayedalamin Zaid
General Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.
Medicine, Al-Rayan Colleges, Al-Madinah, SAU.
Cureus. 2023 Oct 25;15(10):e47646. doi: 10.7759/cureus.47646. eCollection 2023 Oct.
Cholecystectomy is a widespread surgical procedure for gallbladder diseases. Evolving techniques and technologies, such as intraoperative cholangiography (IOC), enhance safety and outcomes by providing real-time biliary system visualization during surgery. This systematic review explored available data on using IOC during cholecystectomy, highlighting its effectiveness, safety, and cost-effectiveness. To perform this systematic review, a thorough literature search was conducted using relevant keywords in electronic databases, such as PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Library, Web of Science, and Google Scholar. We included studies published during the last 10 years exploring the use of IOC during cholecystectomy. The findings showed success rates of up to 90% with a median time of 21.9 minutes without complications. Most (90%) patients with acute gallstone pancreatitis underwent cholecystectomy with IOC, with unclear IOC results in 10.7% and failure in 14.7%. IOC failure factors included age, body mass index (BMI), male sex, concurrent acute cholecystitis, common bile duct (CBD) stone evidence on imaging, CBD diameter of >6 mm, total bilirubin of >4 mg/dL, abnormal liver tests, and gallstone pancreatitis. The detection of choledocholithiasis by IOC prompted trans-cystic duct exploration and endoscopic retrograde cholangiopancreatography (ERCP). Biliary abnormalities and stone identification were observed using IOC, and routine use increased bile duct stone detection while decreasing bile duct injury and readmission rates. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of IOC for common bile duct stone detection were reported at 77%, 98%, 97.2%, 63%, and 99%, respectively. Routine IOC was projected to provide substantial quality-adjusted life years (QALY) and cost-effectiveness gains compared to selective IOC. Regarding safety, IOC was generally associated with reduced complication and open surgery conversion risks, with similar rates of CBD injury and bile leaks. These findings indicate that IOC enhances cholecystectomy outcomes through precision and decreasing complications.
胆囊切除术是一种针对胆囊疾病的广泛开展的外科手术。诸如术中胆管造影（IOC）等不断发展的技术和工艺，通过在手术期间提供实时胆道系统可视化，提高了安全性并改善了手术效果。本系统评价探讨了胆囊切除术中使用IOC的现有数据，突出了其有效性、安全性和成本效益。为进行本系统评价，我们在电子数据库（如PubMed、医学文献分析与检索系统在线数据库（MEDLINE）、Cochrane图书馆、科学引文索引数据库和谷歌学术）中使用相关关键词进行了全面的文献检索。我们纳入了过去10年中探索胆囊切除术中使用IOC的研究。研究结果显示成功率高达90%，中位时间为21.9分钟，且无并发症。大多数（90%）急性胆石性胰腺炎患者接受了IOC辅助的胆囊切除术，IOC结果不明确的占10.7%，失败的占14.7%。IOC失败的因素包括年龄、体重指数（BMI）、男性、并发急性胆囊炎、影像学上有胆总管（CBD）结石证据、CBD直径>6mm、总胆红素>4mg/dL、肝功能检查异常以及胆石性胰腺炎。IOC检测到胆总管结石后促使进行经胆囊管探查和内镜逆行胰胆管造影（ERCP）。使用IOC观察到了胆道异常和结石识别情况，常规使用增加了胆管结石的检测，同时降低了胆管损伤和再入院率。IOC检测胆总管结石的敏感性、特异性、准确性、阳性预测值和阴性预测值分别报告为77%、98%、97.2%、63%和99%。与选择性IOC相比，预计常规IOC可提供显著的质量调整生命年（QALY）并提高成本效益。在安全性方面，IOC通常与降低并发症和转为开放手术的风险相关，CBD损伤和胆漏发生率相似。这些发现表明，IOC通过提高精准度和减少并发症来改善胆囊切除术的效果。
