"伪三角"异常解剖认知在腹腔镜胆囊切除术胆管横断损伤预防中的临床应用OA
The correct understanding of"pseudo-triangle"anatomical abnormalities can reduce the incidence of bile duct transection injury during laparoscopic cholecystectomy
目的 本研究旨在探讨基于"伪三角"异常解剖的认知能否有效降低腹腔镜胆囊切除术(LC)中的胆管横断损伤发生率.方法 回顾性分析川北医学院附属巴中医院的LC病例资料.早期队列:2006年10月至2018年10月期间行LC手术的1 107例患者,将其中发生了胆管横断损伤的35例作为病例组,并随机选取同期140例未发生胆管横断损伤的患者作为对照组,分析胆管横断损伤的危险因素,总结归纳术中所见,定义"伪三角"异常解剖.后期队列:2018年11月至2024年10月期间行LC手术的1 498例患者,此阶段"伪三角"异常解剖的相关概念已通过科室学习、交流等方式被熟知,并在临床实践中得以运用.比较两队列胆管横断损伤发生率变化.结果 早期队列和后期队列在年龄、性别构成、身体质量指数(BMI)、疾病类型等基本资料上差异均无统计学意义(P>0.05)."伪三角"异常解剖、胆管解剖变异及未能实现安全关键视野(CVS)是导致胆管横断损伤的危险因素(P<0.05)."伪三角"异常解剖的认知在临床普及应用后,胆管横断损伤率由早期的3.16%(35/1 107)显著降至后期的0.67%(10/1 498)(P<0.01),损伤主因由早期的"伪三角"误判(68.6%)转变为后期的胆管解剖变异(50.0%).结论 正确认识"伪三角"异常解剖是预防LC术中胆管横断损伤的有效策略.该策略通过识别特定异常解剖、规范牵拉操作,并与CVS标准形成互补,从而降低胆管横断损伤的发生率.
Objective To explore whether cognition based on"pseudo-triangle"abnormal anatomy can effectively reduce the incidence of bile duct transection injury during laparoscopic cholecystectomy(LC).Methods Clinical data of patients who underwent LC at Bazhong Hospital Affiliated to North Sichuan Medical College were retrospectively analyzed.The study included two cohorts.Early cohort(October 2006 to October 2018):Among 1 107 patients,35 who suffered bile duct transection injury were assigned to the case group,while 140 patients without injuries during the same period were randomly selected as the control group.Based on data from the early cohort,to analyze the risk factors for bile duct transection injury,to summarize intraoperative findings,and to define"pseudo-triangle"abnormal anatomy.Late cohort(November 2018 to October 2024):A total of 1 498 patients underwent LC,the concept of"pseudo-triangle"abnormal anatomy at this stage had been well known and had been applied in clinical practice.To compare the incidence change of bile duct transection injury between two cohorts.Results Baseline characteristics(age,gender distribution,body mass index,and types of diagnosis)were comparable between the early cohort and late cohort(P>0.05).Statistical analysis indicated that the presence of the"pseudo-triangle"anomaly,anatomical variation,and failure to achieve the critical view of safety(CVS)were significant risk factors for bile duct transection injury(P<0.05).Following the clinical implementation of the'pseudo-triangle'concept,the incidence of bile duct transection injury was significantly decreased[3.16%(35/1 107)in the early cohort,0.67%(10/1 498)in the late cohort(P<0.01)].The primary cause of injury shifted from"pseudo-triangle"misjudgment(68.6%in the early cohort)to anatomical variation(50.0%in the late cohort).Conclusion Correct recognition of the"pseudo-triangle"anatomical anomaly is an effective strategy for preventing bile duct transection injury during LC.By identifying specific anatomical risks and standardizing surgical traction,this strategy serves as a vital complement to the CVS standard,thereby reducing the incidence of bile duct transection injury.
程祥云;冯志宏;李坚;王良波;魏恒明;曹钰;郭兵;李明月;刘宇;阿木金刚
川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000川北医学院附属巴中医院肝胆胰脾血管外科,四川 巴中 636000
医药卫生
"伪三角"异常解剖腹腔镜胆囊切除术胆管横断损伤
"pseudo-triangle"anatomical abnormalitieslaparoscopic cholecystectomybile duct transection injury
《肝胆胰外科杂志》 2026 (5)
325-331,7
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