胆道镜联合术中胆道造影在困难腹腔镜胆囊切除术中的应用

目的 探讨胆道镜联合术中胆道造影(intraoperative cholangiography,IOC)在困难腹腔镜胆囊切除术(LC)中的应用价值,并分析影响术后并发症发生的相关因素.方法 前瞻性选取2019年6月至2020年9月温州市中西医结合医院收治的符合困难LC诊断的患者186例,随机分为对照组和观察组,每组各9...

Application of choledochoscopy combined with intraoperative cholangiography in difficult laparoscopic cholecystectomy

Objective To investigate the application value of choledochoscopy combined with intraoperative cholangiography (IOC) in difficult laparoscopic cholecystectomy (LC), and to analyze the related factors affecting the occurrence of postoperative complications. Methods A total of 186 patients with difficult LC admitted to Wenzhou Hospital of Intergrated Traditional Chinese and Western Medicine from Jun. 2019 to Sep. 2020 were randomly divided into the control group (n=93) and the observation group (n=93). Patients in control group were treated with conventional difficult LC, and patients in observation group were treated with choledochoscopy combined with IOC in LC. Ratio of bile duct injury, operation time, intraoperative blood loss, time of hospitalization, conversion rate of laparotomy and complications 3 months after operation were compared between the two groups. Univariate analysis and multivariate Logistic regression models were employed to analyze the related factors of postoperative complications. Results There were statistical differences between two groups in terms of operation time [(36.38±4.16)min vs (52.24±8.46)min], intraoperative blood loss [(67.35±6.22)mL vs(86.64±7.69)mL], hospitalization time [(5.72±0.36)d vs (8.45±1.42)d], conversion rate [0 vs 8.60% (8/93)], and the total incidence of postoperative complications [4.30% (4/93) vs 15.05% (14/93)] were all statistically significant (P<0.05), indicators in observation group were all lower than those in control group. Multivariate Logistic analysis showed that age>60 years old (OR 2.128, 95%CI 1.395~2.902), diabetes mellitus (OR 2.526, 95%CI1.682~3.427), operation time ≥40 min (OR 2.318, 95%CI 1.879~2.836), intraoperative blood loss ≥70 mL (OR 2.418, 95%CI 1.389~3.523), and non-intraoperative cholangiography (OR 3.967, 95%CI 2.184~4.853) were independent factors of postoperative complications. Conclusion For difficult LC, choledochoscopy combined with IOC can reduce bile duct injury, operation time, intraoperative blood loss, hospitalization time and conversion laparotomy rate, and postoperative complications. Complications after difficult LC are related to patient’s age, whether or not complicated with diabetes, operation time, intraoperative blood loss, and intraoperative cholangiography