RISK-FACTORS FOR BILE-DUCT INJURY IN LAPAROSCOPIC CHOLECYSTECTOMY - ANALYSIS OF 49 CASES

被引:54
作者
SCHOL, FPG
GO, PMNYH
GOUMA, DJ
机构
[1] UNIV LIMBURG HOSP,DEPT SURG,6202 AZ MAASTRICHT,NETHERLANDS
[2] ACAD MED CTR,AMSTERDAM,NETHERLANDS
关键词
D O I
10.1002/bjs.1800811225
中图分类号
R61 [外科手术学];
学科分类号
摘要
Forty-nine bile duct injuries, representing 0.8 per cent of 6076 laparoscopic cholecystectomies performed in the Netherlands in 1990-1992, were reviewed. The aim of the study was to classify the injuries according to severity, to identify possible risk factors contributing to the aetiology of such injuries and to correlate these with the severity of the injury. On the basis of operative findings, bile duct injuries were classified from minor (classes I-IIIa) to extensive with loss of bile duct tissue (lIIb) or localization in the liver hilum (IV). Of 49 injuries, there were 11 in class I, six in class II, ten in class IIIa, 18 in class IIIb and four in class IV. in 16 patients the injury was detected during laparoscopic cholecystectomy and the procedure converted to laparotomy. The duct injury was minor (class I-IIIa) in 14 of these 16 patients. In 20 of the 33 patients in whom identification of the injury was delayed to a second or third operation, more severe types of injury (classes IIIb and IV) were observed. Delayed detection was associated with greater severity (P=0.002). Of eight patients with histologically proven acute cholecystitis at cholecystectomy, seven suffered severe injury (class IIIb or IV). Surgical experience with laparoscopic cholecystectomy was an important factor in the incidence of bile duct injury.
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页码:1786 / 1788
页数:3
相关论文
共 14 条
[1]  
BLUMGART LH, 1988, SURGERY LIVER BILIAR, V1, P721
[2]  
CAPUTO L, 1992, AM SURGEON, V58, P766
[3]   RECENT RESULTS OF ELECTIVE OPEN CHOLECYSTECTOMY IN A NORTH-AMERICAN AND A EUROPEAN CENTER - COMPARISON OF COMPLICATIONS AND RISK-FACTORS [J].
CLAVIEN, PA ;
SANABRIA, JR ;
MENTHA, G ;
BORST, F ;
BUHLER, L ;
ROCHE, B ;
CYWES, R ;
TIBSHIRANI, R ;
ROHNER, A ;
STRASBERG, SM .
ANNALS OF SURGERY, 1992, 216 (06) :618-626
[4]   COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY - A NATIONAL SURVEY OF 4,292 HOSPITALS AND AN ANALYSIS OF 77,604 CASES [J].
DEZIEL, DJ ;
MILLIKAN, KW ;
ECONOMOU, SG ;
DOOLAS, A ;
KO, ST ;
AIRAN, MC .
AMERICAN JOURNAL OF SURGERY, 1993, 165 (01) :9-14
[5]   WHAT ARE THE CONTRAINDICATIONS FOR LAPAROSCOPIC CHOLECYSTECTOMY [J].
FRAZEE, RC ;
ROBERTS, JW ;
SYMMONDS, R ;
SNYDER, SK ;
HENDRICKS, J ;
SMITH, R ;
CUSTER, MD .
AMERICAN JOURNAL OF SURGERY, 1992, 164 (05) :491-495
[6]   LAPAROSCOPIC CHOLECYSTECTOMY IN THE NETHERLANDS [J].
GO, PMNYH ;
SCHOL, F ;
GOUMA, DJ .
BRITISH JOURNAL OF SURGERY, 1993, 80 (09) :1180-1183
[7]  
GOUMA DJ, 1994, J AM COLL SURGEONS, V178, P229
[8]  
KRAMLING HJ, 1993, CHIRURG, V64, P295
[9]   MULTIPRACTICE ANALYSIS OF LAPAROSCOPIC CHOLECYSTECTOMY IN 1,983 PATIENTS [J].
LARSON, GM ;
VITALE, GC ;
CASEY, J ;
EVANS, JS ;
GILLIAM, G ;
HEUSER, L ;
MCGEE, G ;
RAO, M ;
SCHERM, MJ ;
VOYLES, CR .
AMERICAN JOURNAL OF SURGERY, 1992, 163 (02) :221-226
[10]  
SCHLUMPF R, 1993, CHIRURG, V64, P307