常规/选择性胆道造影在腹腔镜胆囊切除术中的应用研究

Application of Routine or Selective Intraoperative Cholangiography in Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术中常规应用和选择性应用胆道造影的效果。方法常规术中胆道造影组1 520例,选择性术中胆道造影组457例。采用自制造影器或输液针头完成术中造影,比较2组的造影时间、造影成功率、胆总管结石发现率、胆管解剖变异发现率、医源性胆管损伤发生率、中转开腹率以及术后住院时间。结果 2组病例在造影时间、造影成功率、中转开腹率以及术后住院时间方面的差异均无统计学意义(P>0.05);选择性造影组的胆总管结石发现率、胆管解剖变异发现率以及医源性胆管损伤发生率均高于常规造影组(28.25%比13.43%,10.71%比7.43%,2.05%比1.02%,P<0.05)。结论在开展腹腔镜胆囊切除术的早期,应采用常规术中胆道造影,以避免医源性胆管损伤的发生和胆总管结石残留。待技术纯熟以后,可以选择性地进行术中胆道造影。

Objective To explore whether the intraoperative cholangiography（IOC） should be applied in laparoscopic cholecystectomy routinely or selectively.Methods Data of routine IOC group（1 520 patients）and selective IOC group（457 patients）in laparoscopic cholecystectomy were collected and analyzed,including cholangiography time,success rate,common bile duct stones rate,open cholecystectomy rate,and hospital stay after operation.All IOC cases were performed by home-made cholangiography appliance or infusion needle.Results There were no significant differences between routine IOC group and selective IOC group on cholangiography time,success rate,open cholecystectomy rate,and hospital stay after operation（P0.05）.However,compared with routine IOC group,the common bile duct stones rate,anatomic variation rate,and iatrogenic damage rate were significantly higher in selective IOC group（28.25% vs.13.43%,10.71% vs.7.43%,2.05% vs.1.02%,P0.05）.Conclusions For avoiding iatrogenic bile duct damage and residual stones,routine IOC should be applied in early-stage of laparoscopic cholecystectomy,and IOC should be applied selectively when the surgeon have LC technique at their finger ends.