Windsor J A, Vokes D E
University Department of Surgery, Auckland Hospital, New Zealand.
Br J Surg. 1994 Aug;81(8):1208-11. doi: 10.1002/bjs.1800810843.
Data on the incidence, nature and management of early laparoscopic biliary injury up to January 1993 were obtained by a postal questionnaire sent to all New Zealand general surgeons (n = 214; response rate 71 percent) and to all endoscopists who perform endoscopic retrograde cholangiography (n = 16; response rate 100 percent). A total of 41 injuries (surgeons' survey, 22; endoscopists' survey, 19) occurred in an estimated 4000 laparoscopic cholecystectomies; 16 involved the common bile and hepatic ducts, and 25 the cystic and segment V ducts. Operative cholangiography was performed in one patient. The diagnosis of injury was made after operation in 31 of 41 patients and after discharge in 21. Conservative management was undertaken in only 19 patients. This prospective audit documents an increase in the incidence of early biliary injury after the introduction of laparoscopic cholecystectomy in New Zealand. The results highlight the need for further study to determine the best way to ensure early and accurate diagnosis of biliary injury and to define optimal conservative and operative management.
截至1993年1月，通过向所有新西兰普通外科医生（共214名；回复率71%）以及所有进行内镜逆行胆管造影的内镜医师（共16名；回复率100%）发送邮政调查问卷，获取了有关早期腹腔镜胆管损伤的发生率、性质及处理情况的数据。在估计4000例腹腔镜胆囊切除术中，共发生了41例损伤（外科医生调查中22例；内镜医师调查中19例）；16例涉及胆总管和肝管，25例涉及胆囊管和Ⅴ段胆管。仅1例患者进行了术中胆管造影。41例患者中，31例在术后确诊损伤，21例在出院后确诊。仅19例患者采取了保守治疗。这项前瞻性审计记录了新西兰引入腹腔镜胆囊切除术后早期胆管损伤发生率的上升。结果突出表明，需要进一步研究以确定确保早期准确诊断胆管损伤的最佳方法，并确定最佳的保守及手术治疗方案。
