Yarmuch J, Schutte H, Caballero G, Pinto C, Silva J, Silva M
Departamento de Cirugía, Hospital Clínico, Universidad de Chile.
Rev Esp Enferm Dig. 1994 Aug;86(2):587-91.
We present our experience at the University of Chile Hospital with 1203 cases of laparoscopic cholecistectomy between April 1991 and July 1993. In only 36 patients ultraselective cholangiography was performed. In 88 cases an endoscopic cholangiography was performed prior to surgery because of suspicion of choledocolithiasis. In 31 of them choledocolithiasis was demonstrated, and was successfully treated by papilotomy in 30 of them. In 5.8% of cases coversion to open surgery was necessary: 1.4% in chronic cholecystitis, 13% in acute cholecystitis and 39% in cases with fibrosis and esclerosis of gallbladder with or without biliary digestive fistula. The intraoperative cholangiography has been advocated as a manner to prevent the common duct injury. In spite of the small number of cases operated on with cholangiography, we haven't seen serious injuries of biliary tract; a carefully disection, as far away as possible of the common duct, is the best way to prevent iatrogenic lesions. Postoperative morbidity was present in 15 cases, 8 of them required a new operation. Two patients died.
我们介绍了1991年4月至1993年7月期间在智利大学医院进行1203例腹腔镜胆囊切除术的经验。仅对36例患者进行了超选择性胆管造影。88例患者因怀疑胆总管结石在手术前进行了内镜胆管造影。其中31例证实有胆总管结石，30例通过乳头切开术成功治疗。5.8%的病例需要转为开腹手术：慢性胆囊炎患者中占1.4%，急性胆囊炎患者中占13%，胆囊纤维化和硬化伴或不伴有胆肠瘘的患者中占39%。术中胆管造影一直被提倡作为预防胆总管损伤的一种方法。尽管进行胆管造影手术的病例数量较少，但我们尚未见到严重的胆道损伤；尽可能小心地远离胆总管进行解剖是预防医源性损伤的最佳方法。15例患者出现术后并发症，其中8例需要再次手术。2例患者死亡。
