Kullman E, Borch K, Lindström E, Svanvik J, Anderberg B
Department of Surgery, University Hospital of Linköping, Sweden.
Br J Surg. 1996 Feb;83(2):171-5.
A prospective study was performed to determine the frequency and type of bile duct abnormalities, and to determine whether routine use of intraoperative cholangiography during laparoscopic cholecystectomy might aid in the prevention of bile duct injuries. Overall, anatomical aberrations of the bile ducts were found in 98 (19 per cent) of 513 cholangiograms. The most common anomalies were at the hepatic confluence and constituted different types of right hepatic subsegmental ducts draining separately into the biliary tree (n = 43, 8.4 per cent), either close to the cystic duct or directly into the cystic duct. Three bile duct injuries (0.5 per cent) occurred during the study period. These results show that routine intraoperative cholangiography is feasible and provides valuable information about the anatomy of the biliary tract, thereby improving the safety of laparoscopic cholecystectomy. If an injury to the biliary tract occurs early during operation, the cholangiogram allows the surgeon to detect the injury, to make a prompt repair and thereby reduce the morbidity associated with a delayed diagnosis. Routine use of intraoperative cholangiography is strongly recommended.
进行了一项前瞻性研究，以确定胆管异常的频率和类型，并确定在腹腔镜胆囊切除术中常规使用术中胆管造影是否有助于预防胆管损伤。总体而言，在513例胆管造影中，有98例（19%）发现胆管存在解剖变异。最常见的异常发生在肝汇合处，表现为不同类型的右肝段下胆管分别汇入胆管树（n = 43，8.4%），这些胆管要么靠近胆囊管，要么直接汇入胆囊管。在研究期间发生了3例胆管损伤（0.5%）。这些结果表明，常规术中胆管造影是可行的，并且能提供有关胆道解剖的有价值信息，从而提高腹腔镜胆囊切除术的安全性。如果在手术早期发生胆道损伤，胆管造影可使外科医生检测到损伤，及时进行修复，从而降低因延迟诊断而导致的发病率。强烈建议常规使用术中胆管造影。
