Taniguchi Y, Ido K, Kimura K, Yoshida Y, Ohtani M, Kawamoto C, Isoda N, Suzuki T, Kumagai M
Department of Gastroenterology, Jichi Medical School, Tochigi, Japan.
Am J Gastroenterol. 1993 Aug;88(8):1258-61.
Anatomic variations of the biliary tract were found in 18 cases of 600 patients (3.0%) undergoing laparoscopic cholecystectomy. All bile duct anomalies were confirmed preoperatively by endoscopic retrograde cholangiography. In every case, the cystic duct and cystic artery were exposed in a "safety zone" near the gallbladder neck in Calot's triangle. Laparoscopic cholecystectomy was successfully performed on all 18 cases. Intraoperative cholangiography clearly demonstrated the anatomic variations in all cases, unequivocally identified the cystic duct, and confirmed the absence of bile duct injury. Preoperative endoscopic retrograde cholangiography and intraoperative cholangiography, which have been performed routinely in all patients, improve the safety of laparoscopic cholecystectomy. Moreover, the observance of the essential rule of "keep operating in the safety zone" protects against inadvertent complications, especially against bile duct injury during laparoscopic cholecystectomy. Laparoscopic cholecystectomy was thus successfully performed on all 600 cases in the present series, except for three cases, which were converted to open surgery (conversion rates, 0.5%), because of pin-hole bleeding on the portal vein in our first case of 600, and severe adhesion in two (46th and 302nd) cases.
在600例行腹腔镜胆囊切除术的患者中，有18例（3.0%）发现了胆道解剖变异。所有胆管异常均在术前通过内镜逆行胆管造影得以证实。在每一例中，胆囊管和胆囊动脉均在胆囊三角内靠近胆囊颈部的“安全区”暴露。18例患者均成功实施了腹腔镜胆囊切除术。术中胆管造影在所有病例中均清晰显示了解剖变异，明确识别了胆囊管，并证实无胆管损伤。术前内镜逆行胆管造影和术中胆管造影在所有患者中均常规进行，提高了腹腔镜胆囊切除术的安全性。此外，遵守“在安全区内操作”这一基本规则可预防意外并发症，尤其是预防腹腔镜胆囊切除术期间的胆管损伤。因此，本系列600例患者中，除3例因以下原因中转开腹手术（中转率0.5%）外，其余均成功实施了腹腔镜胆囊切除术：600例中的第1例患者门静脉出现针孔状出血；另外2例（第46例和第302例）出现严重粘连。
