Madhavan K K, Macintyre I M, Wilson R G, Saunders J H, Nixon S J, Hamer-Hodges D W
Department of General Surgery, Western General Hospital, Edinburgh, UK.
Br J Surg. 1995 Feb;82(2):249-52. doi: 10.1002/bjs.1800820238.
The results of a policy of selective cholangiography were assessed in 400 patients undergoing laparoscopic cholecystectomy. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 81 patients (20 per cent) of whom 31 (38 per cent) showed definite or possible evidence of stones in the bile duct. Seventeen of the 400 patients underwent intraoperative cholangiography and the majority of these (12) were normal. After a minimum follow-up of 1 year, 17 patients (4 per cent) have had ERCP for suspected residual duct stones. Eight (2 per cent) of these revealed stones and all were successfully treated with sphincterotomy and duct clearance. Preoperative and postoperative ERCP was not associated with mortality or major morbidity. No major duct injury occurred and none was diagnosed within 2 years of operation. Routine intraoperative cholangiography is not a necessary part of laparoscopic cholecystectomy in the presence of an efficient and safe ERCP service.
对400例行腹腔镜胆囊切除术的患者评估了选择性胆管造影术的效果。81例（20%）患者术前行内镜逆行胰胆管造影（ERCP），其中31例（38%）显示胆管内有明确或可能的结石证据。400例患者中有17例术中行胆管造影，其中大多数（12例）结果正常。经过至少1年的随访，17例（4%）患者因怀疑有残余胆管结石而接受了ERCP检查。其中8例（2%）发现有结石，均通过括约肌切开术和胆管清理成功治疗。术前和术后ERCP与死亡率或严重并发症无关。未发生重大胆管损伤，术后2年内也未诊断出此类损伤。在有高效且安全的ERCP服务的情况下，常规术中胆管造影并非腹腔镜胆囊切除术的必要组成部分。
