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首页> 外文期刊>Surgical Endoscopy >Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.
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Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.

机译：腹腔镜胆囊切除术中常规与选择性术中胆管造影术：一项对2,130例接受腹腔镜胆囊切除术的患者的调查。

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BACKGROUND: Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. METHODS: Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. RESULTS: In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. CONCLUSION: RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.
机译：背景：在腹腔镜胆囊切除术（LC）期间常规使用术中胆管造影术（IOC）尚有争议。方法：收集并分析了2130例连续LC的数据以及患者在9年内的随访情况。在研究的前4年中，有800位患者接受了LC，并且有选择地进行了IOC（SIOC）。此后，对1,330例患者进行了LC，并且常规尝试了所有患者的IOC（RIOC）。结果：IOC组中有159例符合SIOC标准，其中141例成功完成（成功率为88.6％）。 9例患者发现胆管结石。所有其他无标准或SIOC失败的患者均得到随访，并记录了9例保留结石的患者。因此，导管结石的发生率为1.1％，检测导管结石的敏感性，特异性，阴性预测值（NPV）和阳性预测值（PPV）分别为50％，100％，98.6％和100％。在RIOC组中，常规行IOC治疗的患者为1,330例，成功率为1,133例（成功率为90.9％; p = 0.015）。在37例患者中检测到胆管结石（包括14例无症状的结石）。在两种情况下，国际奥委会未能发现导管结石（假阴性）。没有假阳性的国际奥委会。因此，采用RIOC政策，导管结石的发生率，敏感性，特异性，NPV和PPV分别为3.3％，97.4、100、99.8和100％（成功率，发生率，敏感性和NPV显着更高; p < 0.05）。 RIOC组的IOC异常结果也明显更高。胆总管损伤仅发生在SIOC组[所有2,130例LC中有2例（0.09％）]。结论：LC期间的RIOC是检测胆管解剖结构和结石的安全，准确，快速且具有成本效益的方法。高度严格的RIOC性能可以最大程度地减少胆管损伤的潜在虚弱和危险并发症。

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