Regöly-Mérei J, Ihász M, Szeberin Z, Sándor J, Máté M
3rd Surgical Department, Semmelweis Medical University, Budapest, Hungary.
Surg Endosc. 1998 Apr;12(4):294-300. doi: 10.1007/s004649900657.
The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy.
A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire.
Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions, more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and advanced age.
The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.
胆道损伤风险较高被认为是腹腔镜胆囊切除术最显著的缺点。
进行了一项全国多中心回顾性研究，以确定1991年1月1日至1994年12月31日期间胆道损伤的发生率、病因及治疗情况。通过问卷调查进行随访。
在26440例腹腔镜胆囊切除术中观察到约148例胆道并发症。一个机构所进行的腹腔镜胆囊切除术数量与胆道损伤及术后胆漏发生率之间未发现显著相关性，但在开展手术的第2年，这两种并发症的发生率均有所下降。在中转手术较多的机构中，也观察到更多胆漏病例。胆道损伤与术后胆漏之间存在显著正相关。静脉内及术中胆管造影和内镜逆行胰胆管造影（ERCP）的使用之间无显著关系。在对损伤类型的单因素分析中，主要治疗方式并未影响损伤的结果或导致再次手术的必要性。解剖结构不清会导致更多的肝外胆管损伤。根据多因素分析，重复干预的必要性和高龄对结果有显著不利影响。
早期研究中提及的胆管损伤风险明显较高这一点未得到证实。
