Lorimer J W, Fairfull-Smith R J
Department of Surgery, University of Ottawa, Ontario, Canada.
Am J Surg. 1995 Mar;169(3):344-7. doi: 10.1016/S0002-9610(99)80173-1.
Whether or not to perform intraoperative cholangiography (IOC) with laparoscopic cholecystectomy is controversial. The decision to perform IOC should depend on the individual surgeon's preference for the management of choledocholithiasis.
An initial experience of 525 patients undergoing laparoscopic cholecystectomy done without IOC is reviewed.
Suspected or proven choledocholithiasis was managed by endoscopic retrograde cholangiography with sphincterotomy if necessary. There were no bile duct injuries or bile leaks, and 9% (47) of patients underwent endoscopic investigation or treatment. There have been no secondary operations for duct stones.
We think that the use of IOC to avoid bile duct injuries is not essential, and that the key to avoiding such injuries is meticulous demonstration of anatomic detail at operation. We have been satisfied with selective use of endoscopic cholangiography and sphincterotomy for the management of choledocholithiasis.
腹腔镜胆囊切除术是否进行术中胆管造影（IOC）存在争议。是否进行IOC的决定应取决于外科医生个人对胆总管结石处理的偏好。
回顾了525例未进行IOC的腹腔镜胆囊切除术患者的初步经验。
如有必要，对疑似或确诊的胆总管结石采用内镜逆行胆管造影及括约肌切开术进行处理。未发生胆管损伤或胆漏，9%（47例）的患者接受了内镜检查或治疗。未因胆管结石进行二次手术。
我们认为，使用IOC来避免胆管损伤并非必要，避免此类损伤的关键在于手术中细致地显露解剖细节。我们对选择性使用内镜胆管造影及括约肌切开术处理胆总管结石感到满意。
