Value of Magnetic Resonance Cholangiopancreatography on Prevention of Complications in Laparoscopic Cholecystectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZOU Hao ¹ , GE Jiayun ¹ , ZHANG Xiaowen ¹ , ZHU Hong ¹ , HAO Jingang ² , WANG Lin ¹ , LI Yuehua. ¹

1.The Second Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical College, Kunming 650101, Yunnan Province, China;;
2.Department of Radiology, The Second Affiliated Hospital of Kunming Medical College, Kunming 650101, Yunnan Province, China;

Corresponding author：

Keywords：

Magnetic resonance cholangiopancreatography; Laparoscopic cholecystectomy; Common bile duct stone; Mirizzi syndrome; Cystic duct; Accessory hepatic duct

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ObjectiveTo evaluate the value of magnetic resonance cholangiopancreatography (MRCP) on prevention of the complications in laparoscopic cholecystectomy (LC). MethodsThe clinical data of 1 079 patients underwent LC from January 2006 to June 2010 in this hospital were retrospectively analyzed. According to the use of MRCP or not in the different period, the patients were divided into nonMRCP group (n=523) and MRCP group (n=556). The occurrence of bile duct injuries (BDI) and retained common duct stone (RCDS) were compared between two groups. ResultsConversion to open surgery was performed in 35 cases in nonMRCP group and in 41 cases in MRCP group. The intraoperative and postoperative BDI were found in five patients and RCDS were found in 27 patients in nonMRCP group, and those were not found in patients in MRCP group. The differences of BDI and RCDS of patients were significant between two groups (P=0.026 and P=0.000). In nonMRCP group, 23 of 55 patients were found common bile duct stones by intraoperative cholangiography. Common bile duct stones were found by intraoperative cholangiography other than preoperative MRCP in three patients in MRCP group, while another three patients did not find common bile duct stones by intraoperative cholangiography although preoperative MRCP suggested. By MRCP, double gallbladders were found in one patient, Mirizzi syndrome in eight patients, variant cystic duct in 34 patients, accessory hepatic duct in 28 patients, and complicating common bile duct stones in 27 patients in MRCP group, the diagnostic accuracy of those were 100%, 87.5%, 94.1%, 89.3% and 88.9%, respectively. ConclusionPreoperative MRCP is helpful to prevent BDI and RCDS for the patients with LC.

Citation： ZOU Hao,GE Jiayun,ZHANG Xiaowen,ZHU Hong,HAO Jingang,WANG Lin,LI Yuehua.. Value of Magnetic Resonance Cholangiopancreatography on Prevention of Complications in Laparoscopic Cholecystectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(9): 973-977. doi: Copy

1.	黄志强，黄晓强，宋青．黄志强胆道外科手术学 [M]．第2版．北京：人民军医出版社， 2010： 340341．.
2.	朱爱军，石景森．胆囊切除术后综合征的再认识 [J]．中国普外基础与临床杂志， 2010， 17（4）： 314316．.
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4.	洪德飞，彭淑牖．腹腔镜肝胆胰脾外科手术操作与技巧 [M]．北京：人民卫生出版社， 2008： 4951．.
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10.	黄晓强，冯玉泉，黄志强．腹腔镜胆囊切除术的并发症(附39 238例分析) [J]．中华外科杂志， 1997， 35（11）： 1517．.
11.	黄志强．医源性胆管损伤: 老问题, 新意义 [J]．中国实用外科杂志， 1999， 19（8）： 34．.
12.	戈佳云，邹浩，李天柱，等．医源性胆管损伤的解剖因素分析 [J]．中国普外基础与临床杂志， 2010， 17（6）： 581585．.
13.	刘杰，宋彬，徐隽，等． MRCP在肝外胆管梗阻中的诊断价值 [J]．中国普外基础与临床杂志， 2005， 12（2）： 188191．.
14.	Charbel H, AlKawas FH. Cholangiocarcinoma: epidemiology, risk factors, pathogenesis, and diagnosis [J]. Curr Gastroenterol Rep, 2011, 13(2): 182187.
15.	Prabhakar PD, Prabhakar AM, Prabhakar HB, et al. Magnetic resonance cholangiopancreatography of benign disorders of the biliary system [J]. Magn Reson Imaging Clin N Am, 2010, 18(3): 497514.
16.	胡国华．影像学检查在壶腹周围癌诊断中的应用价值 [J]．中国普外基础与临床杂志， 2003， 10（5）： 503505．.
17.	李建水，张肇达，唐勇，等．胰管结石的临床分析 [J]．中国普外基础与临床杂志， 2006， 13（4）： 456458．.
18.	Ma ZH, Ma QY, Sha HC, et al. Magnetic resonance cholangiopancreatography for the detection of pancreatic duct stones in patients with chronic pancreatitis [J]. World J Gastroenterol, 2009, 15(20): 25432546.
19.	李汛，李玉民，周文策，等． Mirizzi综合征的术前诊断及其不同类型的手术治疗分析(附86例报道) [J]．中国普外基础与临床杂志， 2009， 16（5）： 393396．.
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21.	夏进东，宋彬，周翔平． Ⅰ型先天性胆管囊肿及合并症的MR诊断与术前评估 [J]．中国普外基础与临床杂志， 2007， 14（3）： 354358．.
22.	文军，杨少华，陈少逸，等．成人Ⅰ型胆总管囊肿的诊治体会 [J]．中国普外基础与临床杂志， 2006， 13（3）： 332333．.
23.	范小涛．低场磁共振MRCP在诊断梗阻性黄疸的临床应用 [J]．重庆医学， 2010， 39（3）： 348349．.
24.	Maccioni F, Martinelli M, Al Ansari N, et al. Magnetic resonance cholangiography: past, present and future: a review [J]. Eur Rev Med Pharmacol Sci, 2010, 14(8): 721725.
25.	陈卫霞，宋彬，陈晓荣，等． MRI对胆囊切除术后胆系并发症的评价 [J]．中国普外基础与临床杂志， 2004， 11（4）： 364368．.
26.	陈圣开，何世举，李映．胆囊切除术后肝外胆管残余结石55例报道 [J]．重庆医学， 2008， 37（21）： 24592461．.

1. 黄志强，黄晓强，宋青．黄志强胆道外科手术学 [M]．第2版．北京：人民军医出版社， 2010： 340341．.
2. 朱爱军，石景森．胆囊切除术后综合征的再认识 [J]．中国普外基础与临床杂志， 2010， 17（4）： 314316．.
3. Csendes A, Díaz JC, Burdiles P, et al. Mirizzi syndrome and cholecystobiliary fistula:a unifying classification[J]. Br J Surg, 1989, 76(11): 11391143.
4. 洪德飞，彭淑牖．腹腔镜肝胆胰脾外科手术操作与技巧 [M]．北京：人民卫生出版社， 2008： 4951．.
5. Hungness ES, Soper NJ. Management of common bile duct stones [J]. J Gastrointest Surg, 2006, 10(4): 612619.
6. Lahmann BE, Adrales G, Schwartz RW. Choledocholithiasisprinciples of diagnosis and management [J]. Curr Surg, 2004, 61(3): 290293.
7. Lill S, Rantala A, Pekkala E, et al. Elective laparoscopic cholecystectomy without routine intraoperative cholangiography: a retrospective analysis of 1 101 consecutive cases [J]. Scand J Surg, 2010, 99(4): 197200.
8. 何德海，甘启祥，杨益森，等．腹腔镜胆囊切除术并发症的诊断和治疗 [J]．中国普外基础与临床杂志， 2009， 16（8）： 661663．.
9. Parmeggiani D, Cimmino G, Cerbone D, et al. Biliary tract injuries during laparoscopic cholecystectomy:three case reports and literature review [J]. G Chir, 2010, 31(12): 1619.
10. 黄晓强，冯玉泉，黄志强．腹腔镜胆囊切除术的并发症(附39 238例分析) [J]．中华外科杂志， 1997， 35（11）： 1517．.
11. 黄志强．医源性胆管损伤: 老问题, 新意义 [J]．中国实用外科杂志， 1999， 19（8）： 34．.
12. 戈佳云，邹浩，李天柱，等．医源性胆管损伤的解剖因素分析 [J]．中国普外基础与临床杂志， 2010， 17（6）： 581585．.
13. 刘杰，宋彬，徐隽，等． MRCP在肝外胆管梗阻中的诊断价值 [J]．中国普外基础与临床杂志， 2005， 12（2）： 188191．.
14. Charbel H, AlKawas FH. Cholangiocarcinoma: epidemiology, risk factors, pathogenesis, and diagnosis [J]. Curr Gastroenterol Rep, 2011, 13(2): 182187.
15. Prabhakar PD, Prabhakar AM, Prabhakar HB, et al. Magnetic resonance cholangiopancreatography of benign disorders of the biliary system [J]. Magn Reson Imaging Clin N Am, 2010, 18(3): 497514.
16. 胡国华．影像学检查在壶腹周围癌诊断中的应用价值 [J]．中国普外基础与临床杂志， 2003， 10（5）： 503505．.
17. 李建水，张肇达，唐勇，等．胰管结石的临床分析 [J]．中国普外基础与临床杂志， 2006， 13（4）： 456458．.
18. Ma ZH, Ma QY, Sha HC, et al. Magnetic resonance cholangiopancreatography for the detection of pancreatic duct stones in patients with chronic pancreatitis [J]. World J Gastroenterol, 2009, 15(20): 25432546.
19. 李汛，李玉民，周文策，等． Mirizzi综合征的术前诊断及其不同类型的手术治疗分析(附86例报道) [J]．中国普外基础与临床杂志， 2009， 16（5）： 393396．.
20. 李晓，戈佳云，崔江云． Mirizzi综合征临床诊治体会(附38例报道) [J]．中国普外基础与临床杂志， 2008， 15（7）： 522523．.
21. 夏进东，宋彬，周翔平． Ⅰ型先天性胆管囊肿及合并症的MR诊断与术前评估 [J]．中国普外基础与临床杂志， 2007， 14（3）： 354358．.
22. 文军，杨少华，陈少逸，等．成人Ⅰ型胆总管囊肿的诊治体会 [J]．中国普外基础与临床杂志， 2006， 13（3）： 332333．.
23. 范小涛．低场磁共振MRCP在诊断梗阻性黄疸的临床应用 [J]．重庆医学， 2010， 39（3）： 348349．.
24. Maccioni F, Martinelli M, Al Ansari N, et al. Magnetic resonance cholangiography: past, present and future: a review [J]. Eur Rev Med Pharmacol Sci, 2010, 14(8): 721725.
25. 陈卫霞，宋彬，陈晓荣，等． MRI对胆囊切除术后胆系并发症的评价 [J]．中国普外基础与临床杂志， 2004， 11（4）： 364368．.
26. 陈圣开，何世举，李映．胆囊切除术后肝外胆管残余结石55例报道 [J]．重庆医学， 2008， 37（21）： 24592461．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Magnetic Resonance Cholangiopancreatography on Prevention of Complications in Laparoscopic Cholecystectomy

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