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首页> 外文期刊>Surgical Endoscopy >Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era: alarming trends.
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Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era: alarming trends.

机译：腹腔镜时代开放式和腹腔镜胆囊切除术中的胆管损伤：令人震惊的趋势。

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BACKGROUND: After the introduction of laparoscopic cholecystectomy (LC), scientific discussion and concern about iatrogenic bile duct injuries (BDIs) have been limited mostly to BDIs sustained in LC, while BDIs sustained in open cholecystectomy (OC) and in all cholecystectomies have not been the center of attention. METHODS: This study included all patients who sustained BDI in OC or LC in southwest Finland between 1997 and 2007. All data were collected retrospectively in June 2009. RESULTS: Altogether 75 BDIs were encountered in a total of 8349 cholecystectomies, for an overall incidence of 0.90%. Twenty BDIs (15 Amsterdam type A and 5 type B, C, or D) occurred in the 1616 OCs (incidence rate = 1.24%), and 55 (26 type A and 29 type B, C, or D) in the 6733 LCs (incidence rate = 0.82%). All the BDIs in the OCs were missed while 11/29 of the major BDIs in the LCs were detected at the time of surgery. Fifty-four of 59 type A, B, and C BDIs could be treated endoscopically. CONCLUSIONS: In the laparoscopic era, OC is associated with a high number of BDIs, if minor BDIs are included. Excluding some major LC BDIs, BDIs are, as a rule, missed at the time of surgery. More than 90% of Amsterdam types A, B, and C BDIs can be treated endoscopically, whereas type D BDI remains an absolute indication for surgery.
机译：背景：腹腔镜胆囊切除术（LC）引入后，关于医源性胆管损伤（BDI）的科学讨论和关注主要限于LC维持的BDI，而开腹胆囊切除术（OC）和所有胆囊切除术中维持的BDI尚未关注的中心。方法：本研究包括1997年至2007年在芬兰西南部所有患有OC或LC BDI的患者。所有数据均于2009年6月进行回顾性收集。结果：在总共8349例胆囊切除术中共发现75种BDI，总发病率为0.90％。 1616个OC中发生了20个BDI（15个阿姆斯特丹A型和5个B，C或D型）（发生率= 1.24％），在6733个LC中发生了55个（B型26个A和29型B，C或D型） （发生率= 0.82％）。 OC中的所有BDI都被漏掉了，而LC中主要BDI的11/29在手术时被检测到了。可以在内窥镜下治疗59种A，B和C型BDI中的54种。结论：在腹腔镜时代，如果包括少量BDI，则OC与大量BDI相关。除了一些主要的LC BDI以外，通常在手术时会漏掉BDI。阿姆斯特丹内90％以上的A，B和C型BDI均可通过内窥镜治疗，而D型BDI仍是手术的绝对指征。

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