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首页> 外文期刊>Surgical Endoscopy >Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era
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Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era

机译：胆管损伤（BDI）在晚期腹腔镜胆囊切除术时代

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BackgroundLaparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. It is superior in nearly every regard compared to open cholecystectomies. The one significant aspect where the laparoscopic approach is inferior regards the association with bile duct injuries (BDI). The BDI rate with laparoscopic cholecystectomy is approximately 0.5%; nearly triple the rate compared to the open approach. We propose that 0.5% BDI rate with the laparoscopic approach is no longer accurate.MethodsThe National Surgical Quality Improvement Program (NSQIP) registry was retrospectively reviewed. All laparoscopic cholecystectomies performed between 2012 and 2016 were extracted. A total of 217,774 cases meeting inclusion criteria were analyzed. The primary data points were the overall BDI incidence rate and time of diagnosis. BDI were identified by ICD-9 and ICD-10 codes. Secondary data points were variables associated with BDI.ResultsThe BDI rate was 0.19%. 77% of cases were diagnosed after the index surgical admission. Intra-operative cholangiography (IOC) use was associated with a higher BDI rate and higher identification rate of a BDI intraoperatively (P value <0.0001). Resident teaching cases were protective with a RR score of 0.56 (P value <0.0001). The presence of cholecystitis increased the risk of a BDI with a RR score of 1.20 (P value <0.0001). There was a low conversion rate of 0.04% however converted cases had a nearly hundredfold increase in BDI at 15% (P value <0.0001).ConclusionsThe performance of laparoscopic cholecystectomies in North America is no longer associated with higher BDI rates compared to open. IOC use still is not protective against BDI, and cholecystitis continues to be a risk factor for BDI. When a cholecystectomy requires conversion from a laparoscopic to an open approach the BDI increases a hundredfold; which may raise the concern if this approach is still a safe bailout method for a difficult laparoscopic dissection.
机译：BackgroundArapharopic胆囊切除术是最常见的腹腔镜手术。与开放的胆囊切除术相比，几乎每一切都是优越的。腹腔镜方法是较差的关于与胆管损伤（BDI）的关联的一个重要方面。腹腔镜胆囊切除术的BDI率约为0.5％;与开放方法相比近三倍。我们提出，随着腹腔镜方法的0.5％BDI率不再准确。批评国家外科质量改进计划（NSQIP）注册机构。在2012和2016之间进行的所有腹腔镜胆囊切除术都被提取。分析了总共217,774案案件纳入标准。主要数据点是整体BDI发病率和诊断时间。通过ICD-9和ICD-10代码确定BDI。辅助数据点是与BDI相关联的变量。BDI率为0.19％。在指数手术入院后，77％的病例被诊断出来。术中胆管造影（IOC）用途与较高的BDI速率和腹部BDI的识别率较高相关（P值<0.0001）。居民教学案例具有保护性，RR得分为0.56（P值<0.0001）。胆囊炎的存在增加了BDI的风险，RR得分为1.20（P值<0.0001）。较低的转化率为0.04％，但转化的病例在15％（P值<0.0001）下的BDI近百倍增加（P值<0.0001）。与开放相比，北美腹腔镜胆囊切除术的组合性能不再与BDI率更高的联系。 IOC使用仍然没有保护BDI，胆囊炎仍然是BDI的危险因素。当胆囊切除术需要从腹腔镜转换到开放方法时，BDI增加了百倍;如果这种方法仍然是用于困难的腹腔镜解剖的安全救助方法，可能会提高关注。

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