MacFadyen B V, Vecchio R, Ricardo A E, Mathis C R
Department of Surgery, University of Texas Medical School, Houston, 77030, USA.
Surg Endosc. 1998 Apr;12(4):315-21. doi: 10.1007/s004649900661.
Forty series reporting experience with laparoscopic cholecystectomy in the United States from 1989 to 1995 were reviewed. A total of 114,005 cases were analyzed and 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were recorded. Intraoperative cholangiography (IOC) was attempted in 41.5% of the laparoscopic cholecystectomies and was successful in 82.7%. In major bile duct injuries, the common bile duct/common hepatic duct were the most frequently injured (61.1%) and only 1.4% of the patients had complete transection.
When reported, most of the bile duct injuries were managed surgically with a biliary-enteric anastomosis (41.8%) or via laparotomy and t-tube or stent placement (27.5%). The long-term success rate could not be determined because of the small number of series reporting this information. The management for bile leaks usually consisted of a drainage procedure (55.3%) performed endoscopically percutaneously, or operatively.
The morbidity for laparoscopic cholecystectomy, excluding bile duct injuries or leaks, was 5.4% and the overall mortality was 0.06%. It was also noted that the conversion rate to an open procedure was 2.16%.
It is concluded based on this review of laparoscopic cholecystectomies that the morbidity and mortality rates are similar to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholecystectomy. Furthermore, bile duct injuries can be minimized by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle, the cystic duct-gallbladder junction, and the cystic duct-common bile duct junction.
回顾了1989年至1995年美国40个系列关于腹腔镜胆囊切除术的报告经验。共分析了114,005例病例，记录到561例主要胆管损伤（0.50%）和401例胆囊管或肝床胆汁漏（0.38%）。41.5%的腹腔镜胆囊切除术尝试了术中胆管造影，成功率为82.7%。在主要胆管损伤中，胆总管/肝总管是最常受损的部位（61.1%），只有1.4%的患者发生完全横断。
报告显示，大多数胆管损伤通过胆管-肠道吻合术（41.8%）或开腹手术并放置T管或支架（27.5%）进行手术处理。由于报告该信息的系列数量较少，无法确定长期成功率。胆汁漏的处理通常包括内镜下、经皮或手术进行的引流操作（55.3%）。
腹腔镜胆囊切除术的发病率（不包括胆管损伤或漏）为5.4%，总体死亡率为0.06%。还注意到转为开放手术的比例为2.16%。
基于对腹腔镜胆囊切除术的这项回顾得出结论，其发病率和死亡率与开放手术相似。此外，胆管损伤和漏的发生率高于开放胆囊切除术。此外，通过胆囊颈部的侧向牵拉以及仔细解剖胆囊三角、胆囊管-胆囊交界处和胆囊管-胆总管交界处，可以将胆管损伤降至最低。
