Ido K, Isoda N, Kawamoto C, Suzuki T, Ioka T, Nagamine N, Taniguchi Y, Kumagai M, Kimura K
Department of Endoscopy, Jichi Medical School, Yakushiji, Tochigi 329-04, Japan.
Surg Endosc. 1996 Aug;10(8):798-800. doi: 10.1007/s004649900163.
Creating a "safety zone" during laparoscopic cholecystectomy is defined as dissection of the cystic duct as close as possible to the gallbladder.
In 29 out of 802 cases in which laparoscopic cholecystectomy was difficult to perform due to uncertainty about the orientation of Calot's triangle, intraoperative cholangiography was performed, using a titanium clip as a marker that designated the safety zone. The distance between the clip and the common hepatic duct or the common bile duct could be determined by evaluation of two intraoperative cholangiograms taken in different orientation.
If the clip was located in the safety zone, and was distant from the common hepatic duct or common bile duct, the safety of preparation around the clip was ensured. No complication was encountered in these cases with this method. Eventually, no biliary tract injury was experienced, and the overall conversion rate to open cholecystectomy was only 0.4% (3 of 802 consecutive cases).
This method of confirming the safety zone by intraoperative cholangiography is a useful procedure for avoiding inadvertent injury to the biliary tract.
在腹腔镜胆囊切除术中创建“安全区”被定义为尽可能靠近胆囊分离胆囊管。
在802例因Calot三角方向不确定而难以进行腹腔镜胆囊切除术的病例中，有29例进行了术中胆管造影，使用钛夹作为标记来确定安全区。通过评估在不同方向拍摄的两张术中胆管造影照片，可以确定夹子与肝总管或胆总管之间的距离。
如果夹子位于安全区内，且与肝总管或胆总管有一定距离，则可确保夹子周围操作的安全性。采用此方法的这些病例未出现并发症。最终，未发生胆道损伤，连续802例病例的总体开腹胆囊切除术转化率仅为0.4%（3例）。
这种通过术中胆管造影确认安全区的方法是避免意外胆道损伤的有用步骤。
