Clinical Study of “Common Bile Duct Window”_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Shuhua , MA Jun , HUANG Zhongli , SHU Ye.

Department of Anal-Colorectal Surgery, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: SHU Ye, E-mail: sy999222@yahoo.cn;

Corresponding author：

Keywords：

Common bile duct window; Laparoscopic cholecystectomy; Bile duct injury; Anatomy marker

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Objective 　To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. 　　　　Methods 　From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test.
　Results 　“Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （P gt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）.
　Conclusion 　An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.

Citation： LUO Shuhua,MA Jun,HUANG Zhongli,SHU Ye.. Clinical Study of “Common Bile Duct Window”. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(3): 215-217. doi: Copy

1.	Mühe E. Laparoscopic cholecystectomy—late results [Ｊ]. Langenbecks Arch Chir Suppl Kongressbd, 1991:416.
2.	Sváb J, Pesková M, Krska Z, et al. Prevention, diagnosis and treatment of iatrogennic lesions of biliary tract during laparoscopic cholecystectomy. Management of papila injury after invasive endoscopy. Part 1. Prevention and diagnosis of bile duct injuries [Ｊ]. Rozhl Chir, 2005; 84(4):176.
3.	Sinha R. Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice? [Ｊ]. HPB (Oxford), 2008; 10(5):332.
4.	Yaghoubian A, Saltmarsh G, Rosing DK, et al. Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek [Ｊ]. Arch Surg, 2008; 143(9):847.
5.	陈颢，田建伟，李建华. 腹腔镜胆囊切除手术前后肝外胆管直径变化的临床研究 [Ｊ]. 中国普外基础与临床杂志， 2008; 12(10):768.
6.	巴明臣，黄祥成. 我国胆道外科的现状及未来 [Ｊ]. 中国普外基础与临床杂志， 2005; 12(6):628.
7.	Thurley PD, Dhingsa R. Laparoscopic cholecystectomy: postoperative imaging [Ｊ]. AJR Am J Roentgenol, 2008; 191(3):794.
8.	de Reuver PR, Sprangers MA, Rauws EA, et al. Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment [Ｊ]. Endoscopy, 2008; 40(8):637.
9.	〖ＫＧ＊2／３〗〖ＺＫ（〗Traverso LW. Risk factors for intraoperative injury during cholecystectomy: an ounce of prevention is worth a pound of cure [Ｊ]. Ann Surg, 1999; 229(4):458.
10.	Goykhman Y, Kory I, Small R, et al. Long-term outcome and risk factors of failure after bile duct injury repair [Ｊ]. J Gastrointest Surg, 2008; 12(8):1412.
11.	Ortega-Deballon P, Cheynel N, Benoit L, et al. Iatrogenic biliary injuries during cholecystectomy [Ｊ]. J Chir (Paris), 2007; 144(5):409.
12.	Kapoor VK. Bile duct injury repair: when? what? who? [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5):476.
13.	Gottlieb. Injury to bile duct during cholecystectomy nearly triples risk of death [Ｊ]. BMJ, 2003; 327(7):946.
14.	Melton GB, Lillemoe KD, Cameron JL, et al. Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life [Ｊ]. Ann Surg, 2002; 235(6):888.
15.	Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective [Ｊ]. Ann Surg, 2003; 237(4):460.
16.	王俭，范明，修瑞龄，等. 丝线结扎胆囊颈管和胆囊动脉在LC中的应用 [Ｊ]. 中国普外基础与临床杂志， 2006; 14(4):459.
17.	潘雷. 三孔法腹腔镜胆囊切除术106例体会 [Ｊ]. 中国普外基础与临床杂志， 2006； 11(6):712.
18.	Nuzzo G, Giuliante F, Persiani R. The risk of biliary ductal injury during laparoscopic cholecystectomy [Ｊ]. J Chir (Paris), 2004; 141(6):343.
19.	周新华，李宏，陆才德，等. 腹腔镜胆囊切除术中预防胆管损伤的经验（附2 694例报告） [Ｊ]. 中国普外基础与临床杂志, 2003; 10(5):499.
20.	黎前德，杨培，王东，等. 13 840例腹腔镜手术临床分析 [Ｊ]. 中国普外基础与临床杂志， 2005; 11(6):554.

1. Mühe E. Laparoscopic cholecystectomy—late results [Ｊ]. Langenbecks Arch Chir Suppl Kongressbd, 1991:416.
2. Sváb J, Pesková M, Krska Z, et al. Prevention, diagnosis and treatment of iatrogennic lesions of biliary tract during laparoscopic cholecystectomy. Management of papila injury after invasive endoscopy. Part 1. Prevention and diagnosis of bile duct injuries [Ｊ]. Rozhl Chir, 2005; 84(4):176.
3. Sinha R. Early laparoscopic cholecystectomy in acute biliary pancreatitis: the optimal choice? [Ｊ]. HPB (Oxford), 2008; 10(5):332.
4. Yaghoubian A, Saltmarsh G, Rosing DK, et al. Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek [Ｊ]. Arch Surg, 2008; 143(9):847.
5. 陈颢，田建伟，李建华. 腹腔镜胆囊切除手术前后肝外胆管直径变化的临床研究 [Ｊ]. 中国普外基础与临床杂志， 2008; 12(10):768.
6. 巴明臣，黄祥成. 我国胆道外科的现状及未来 [Ｊ]. 中国普外基础与临床杂志， 2005; 12(6):628.
7. Thurley PD, Dhingsa R. Laparoscopic cholecystectomy: postoperative imaging [Ｊ]. AJR Am J Roentgenol, 2008; 191(3):794.
8. de Reuver PR, Sprangers MA, Rauws EA, et al. Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment [Ｊ]. Endoscopy, 2008; 40(8):637.
9. 〖ＫＧ＊2／３〗〖ＺＫ（〗Traverso LW. Risk factors for intraoperative injury during cholecystectomy: an ounce of prevention is worth a pound of cure [Ｊ]. Ann Surg, 1999; 229(4):458.
10. Goykhman Y, Kory I, Small R, et al. Long-term outcome and risk factors of failure after bile duct injury repair [Ｊ]. J Gastrointest Surg, 2008; 12(8):1412.
11. Ortega-Deballon P, Cheynel N, Benoit L, et al. Iatrogenic biliary injuries during cholecystectomy [Ｊ]. J Chir (Paris), 2007; 144(5):409.
12. Kapoor VK. Bile duct injury repair: when? what? who? [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5):476.
13. Gottlieb. Injury to bile duct during cholecystectomy nearly triples risk of death [Ｊ]. BMJ, 2003; 327(7):946.
14. Melton GB, Lillemoe KD, Cameron JL, et al. Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life [Ｊ]. Ann Surg, 2002; 235(6):888.
15. Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective [Ｊ]. Ann Surg, 2003; 237(4):460.
16. 王俭，范明，修瑞龄，等. 丝线结扎胆囊颈管和胆囊动脉在LC中的应用 [Ｊ]. 中国普外基础与临床杂志， 2006; 14(4):459.
17. 潘雷. 三孔法腹腔镜胆囊切除术106例体会 [Ｊ]. 中国普外基础与临床杂志， 2006； 11(6):712.
18. Nuzzo G, Giuliante F, Persiani R. The risk of biliary ductal injury during laparoscopic cholecystectomy [Ｊ]. J Chir (Paris), 2004; 141(6):343.
19. 周新华，李宏，陆才德，等. 腹腔镜胆囊切除术中预防胆管损伤的经验（附2 694例报告） [Ｊ]. 中国普外基础与临床杂志, 2003; 10(5):499.
20. 黎前德，杨培，王东，等. 13 840例腹腔镜手术临床分析 [Ｊ]. 中国普外基础与临床杂志， 2005; 11(6):554.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of “Common Bile Duct Window”

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