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首页> 外文期刊>Surgical Endoscopy >Bile duct injury after laparoscopic cholecystectomy. The United States experience.
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Bile duct injury after laparoscopic cholecystectomy. The United States experience.

机译：腹腔镜胆囊切除术后胆管损伤。美国的经验。

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摘要

BACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
机译：背景：回顾了1989年至1995年在美国进行的40例腹腔镜胆囊切除术的报道经验。共分析了114,005例病例，记录了561例主要胆管损伤（0.50％）和401例胆囊管或肝床胆漏（0.38％）。腹腔镜胆囊切除术中尝试进行术中胆管造影（IOC），成功率为82.7％。在严重的胆管损伤中，胆总管/肝总管受伤最频繁（61.1％），只有1.4％的患者完全横断。方法：据报道，大多数胆管损伤的手术治疗为胆肠吻合术（41.8％）或通过剖腹术和T型管或支架置入术（27.5％）。由于报告此信息的系列数量很少，因此无法确定长期成功率。胆汁泄漏的处理通常由经皮内镜或手术进行的引流程序（55.3％）组成。结果：除胆管损伤或渗漏外，腹腔镜胆囊切除术的发病率为5.4％，总死亡率为0.06％。还注意到，向开放程序的转化率为2.16％。结论：基于对腹腔镜胆囊切除术的回顾，得出的结论是发病率和死亡率与开放手术相似。此外，胆管损伤和渗漏的发生率高于开放性胆囊切除术。此外，胆管颈的侧向缩回和仔细解剖Calot三角形，胆囊管-胆囊结点和胆囊管-常见胆管结点可以最大程度地减少胆管损伤。

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