Value of intraoperative cholangiography in laparoscopic cholecystectomy

被引:0
作者
Ludwig, K [1 ]
Wuschek, M [1 ]
Lorenz, D [1 ]
机构
[1] Univ Greifswald, Chirurg Klin & Poliklin, Abt Viszeralchirurg, D-17487 Greifswald, Germany
来源
ZENTRALBLATT FUR CHIRURGIE | 1997年 / 122卷 / 12期
关键词
intraoperative cholangiography; laparoscopic cholecystectomy; intravenous cholangiography;
D O I
暂无
中图分类号
R61 [外科手术学];
学科分类号
摘要
By introduction of laparoscopic cholecystectomy, increase of accidental common bile duct injuries up to 1.2% has been reported. In the present study of 325 cholecystectomies we evaluated whether mandatory intraoperative cholangiography (IOC) can reduce the rate of accidental bile duct injuries or, at least, identify them early in order to make an adequate repair possible. In addition 163 patients underwent preoperative intravenous cholangiography (IVC). Both imaging techniques were compared with regard to their sensitivity in the detection of anatomic variations and stones of the extrahepatic bile duct system. Our results demonstrated a great advantage of the IOC. The IOC was feasible in 98.1% of the cases and presented a complete depiction of the extrahepatic bile duct system in 99.3%. IVCs showed the biliary system in 91.4% of the cases but without visualization of the cystic duct in 51.5% and the hepatic confluence in 16%. Anatomic variations of the bile duct system which consecutively influenced the operative management were found in additional 27.6% exclusively by IOC. 71.4% of bile duct stones were not detected by IVC. The intraoperative time consumption of IOC was unimportant. The x-ray-load was clearly lower by a factor of 3.5. There was no complication after IOC. In comparison, 6.1% of patients demonstrated an anaphylactic reaction by IVC. One common duct injury (0.3%) was detected intraoperatively by IOC and at the same operation treated without postoperative complications. In conclusion, we recommend an IOC in addition to a thorough preoperative ultrasound-examination. By this technique intraoperatively-identified stones of the common bile duct can be sufficiently treated by postoperative endoscopic extraction and anatomic variations of the bile duct system will be visualized and therefore accidental injuries will be avoided.
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收藏
页码:1078 / 1082
页数:5
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