Ladocsi L T, Benitez L D, Filippone D R, Nance F C
Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey 07039, USA.
Am Surg. 1997 Feb;63(2):150-6.
Intraoperative cholangiography was first introduced by Mirizzi in 1931. He recommended its routine use. The debate over the appropriate role of intraoperative cholangiography was renewed by the widespread acceptance of laparoscopic cholecystectomy in 1988. We reviewed our experience to determine the most appropriate use of intraoperative cholangiography. Seven hundred thirty-four consecutive cases of laparoscopic cholecystectomy performed between January 1, 1991 and December 31, 1993 were reviewed. The Routine Group of 276 cases, performed by 3 surgeons practicing routine cholangiography, was compared to the Selective Group of 458 cases, performed by 16 surgeons practicing selective cholangiography. The groups were similar in terms of age, sex, and extent of disease. No statistically significant difference was found between the two groups in number of successful cholangiograms, filling defects, misinterpretation of cholangiograms, complications, or length of hospitalization. One common duct injury occurred in the Routine Group. The rate of conversion to open cholecystectomy was higher in the Routine Group. A cholangiogram added 14 minutes to the average duration of surgery and $737 to the average cost. We found that routine cholangiography did not increase common duct stone detection, did not decrease common duct injury, and did not increase technical skill, but it did increase cost. We feel that intraoperative cholangiography should be used selectively where choledocholithiasis is suspected or biliary anatomy is unclear.
术中胆管造影术由米里齐于1931年首次引入。他建议常规使用该技术。1988年腹腔镜胆囊切除术被广泛接受后，关于术中胆管造影术适当作用的争论再次兴起。我们回顾了我们的经验，以确定术中胆管造影术的最合适用途。对1991年1月1日至1993年12月31日期间连续进行的734例腹腔镜胆囊切除术病例进行了回顾。由3名实施常规胆管造影术的外科医生完成的276例常规组病例，与由16名实施选择性胆管造影术的外科医生完成的458例选择性组病例进行了比较。两组在年龄、性别和疾病程度方面相似。两组在成功胆管造影的数量、充盈缺损、胆管造影的错误解读、并发症或住院时间方面均未发现统计学上的显著差异。常规组发生了1例胆总管损伤。常规组中转开腹胆囊切除术的比例更高。胆管造影使手术平均持续时间增加了14分钟，平均费用增加了737美元。我们发现常规胆管造影术并没有增加胆总管结石的检出率，没有降低胆总管损伤率，也没有提高技术技能，但确实增加了成本。我们认为，在怀疑有胆总管结石或胆管解剖结构不清楚的情况下，应选择性地使用术中胆管造影术。
