Clinical application of selective intraoperative cholangiography in biliary system surgery

Objective To investigate the value of selective intraoperative cholangiography( IOC) in biliary system surgery. Methods A retrospective analysis was performed on the clinical data and follow- up data of 112 patients who were hospitalized in The First People's Hospital of Pingdingshan and underwent selective IOC from May 2010 to May 2015. Another 84 patients who met the criteria for selective IOC but underwent no IOC or failed IOC were enrolled as controls. The clinical data and follow- up data were compared between the two groups.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results In the selective IOC group,82 patients underwent laparoscopic IOC( 19 were converted to open surgery after IOC) and 30 underwent open IOC; 40 patients had positive results on IOC,among whom 24 had biliary calculi,4 had biliary stricture,1had space- occupying lesions at the lower end of bile duct,5 had bile duct injury,and 6 had negative bile duct exploration. In the control group,53 patients underwent intraoperative bile duct exploration,among whom 26 had biliary calculi,2 had inflammatory stricture at the lower end of bile duct,and 25 had negative results. The negative exploration rate showed a significant difference between the selective IOC group and the control group [15. 00%( 6 /40) vs 47. 17%( 25 /53),χ2= 10. 616,P = 0. 001]. In the selective IOC group,1 patient( 0. 89%) experienced postoperative bile leakage caused by bile duct injury,which was noticed during the surgery and treated with bile duct repair and T- tube drainage,and the patient was cured 2 weeks later. In the control group,7 patients( 8. 33%) experienced postoperative bile duct injury and required reoperation or endoscopic treatment. The incidence rate of bile duct injury showed a significant difference between the two groups( χ2= 6. 787,P = 0. 009). Within half a year after surgery,2 patients( 1. 79%) in the selective IOC group and 12 patients( 14. 29%) in the control group experienced biliary calculi,and the incidence rate of biliary calculi showed a significant difference between the two groups( χ2= 11. 308,P = 0. 001). Conclusion Selective IOC can effectively reduce unnecessary bile duct exploration,the probability of bile duct injury,and the incidence of postoperative residual calculi,identify bile duct injury as early as possible during surgery,reduce the probability of reoperation,relieve pain,and reduce costs; therefore,it helps with bile duct exploration.