Bouillot J L, Fernandez F J, Dehni N, Salah S, al Hajj G, Badawy A, Alexandre J H
Service de Chirurgie Générale et Digestive, Hôpital Broussais, Paris.
Gastroenterol Clin Biol. 1995 Mar;19(3):287-90.
Laparoscopic cholecystectomy has become the therapeutic gold standard in uncomplicated cases of cholelithiasis. This study evaluated the feasibility and the results of intra-operative cholangiography during laparoscopic cholecystectomy.
Intra-operative cholangiography was attempted in 126 consecutive patients undergoing laparoscopic cholecystectomy. Common bile duct stones were detected according to the following criteria: a) clinically (history of jaundice or pancreatitis); b) biologically (aminotransferase > 2 N, alkaline phosphatase > 2 N, total bilirubin > 20 mumol/L); c) ultrasonographically (diameter of the common bile duct > 12 mm, presence of gallbladder stones < 10 mm); d) calculation of the multifactorial score of Huguier.
An intraoperative cholangiography was performed in 116 patients (92%), for a mean duration of 16 minutes (range: 9-25 min). Two anomalies of the biliary tree were detected. Ten common bile duct stones were detected (8.6% with 50% success of laparoscopic extraction). One false positive case had justified a surgical exploration of the common bile duct. The sensitivity of preoperative criteria was 80%. No morbidity or postoperative biliary complications were related to the intraoperative cholangiography.
Routine intraoperative cholangiography should be systematically performed during laparoscopic cholecystectomy, providing anatomical information of the biliary tree and detecting, in 1.7% of cases, unsuspected common bile duct stones which could be treated during the same operative procedure.
腹腔镜胆囊切除术已成为无并发症胆结石病例的治疗金标准。本研究评估了腹腔镜胆囊切除术中术中胆管造影的可行性及结果。
对连续126例行腹腔镜胆囊切除术的患者尝试进行术中胆管造影。根据以下标准检测胆总管结石：a）临床标准（黄疸或胰腺炎病史）；b）生物学标准（转氨酶>2倍正常上限、碱性磷酸酶>2倍正常上限、总胆红素>20μmol/L）；c）超声标准（胆总管直径>12mm、存在直径<10mm的胆囊结石）；d）计算胡吉尔多因素评分。
116例患者（92%）进行了术中胆管造影，平均持续时间为16分钟（范围：9 - 25分钟）。检测到2例胆道树异常。检测到10例胆总管结石（8.6%，腹腔镜取石成功率为50%）。1例假阳性病例促使对胆总管进行了手术探查。术前标准的敏感性为80%。未发现与术中胆管造影相关的术后发病率或胆道并发症。
在腹腔镜胆囊切除术中应系统地常规进行术中胆管造影，它能提供胆道树的解剖信息，并在1.7%的病例中检测到意外的胆总管结石，这些结石可在同一手术过程中得到治疗。
