Abstract Background Each year 13 000 patients undergo cholecystectomy in Sweden, and routine intraoperative cholangiography (IOC) is recommended to minimize bile duct injuries. The risk of requiring endoscopic retrograde cholangiopancreatography (ERCP) following cholecystectomy for common bile duct (CBD) stones where IOC is omitted and in patients with CBD stones left in situ is not well known. Methods Data were retrieved from the population-based Swedish Registry of Gallstone Surgery and ERCP between 1 January 2009 and 10 December 2019. Primary outcome was risk for postoperative ERCP for retained CBD stones. Results A total of 134 419 patients that underwent cholecystectomy were included and 2691 (2.0 per cent) subsequently underwent ERCP for retained CBD stones. When adjusting for emergency or planned cholecystectomy, preoperative symptoms suggestive of CBD stones, sex and age, there was an increased risk for ERCP when IOC was not performed (hazard ratio (HR) 1.4, 95 per cent c.i. 1.3 to 1.6). The adjusted risk for ERCP was also increased if CBD stones identified by IOC were managed with surveillance (HR 5.5, 95 per cent c.i. 4.8 to 6.4). Even for asymptomatic small stones (less than 4 mm), the adjusted risk for ERCP was increased in the surveillance group compared with the intervention group (HR 3.5, 95 per cent c.i. 2.4 to 5.1). Conclusion IOC plus an intervention to remove CBD stones identified during cholecystectomy was associated with reduced risk for retained stones and unplanned ERCP, even for the smallest asymptomatic CBD stones.

中文翻译：

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术中胆管造影检测出胆总管结石患者的干预与监测：一项基于人群的登记研究

摘要 背景瑞典每年有 13 000 名患者接受胆囊切除术，建议常规术中胆管造影 (IOC) 以尽量减少胆管损伤。对于省略 IOC 的胆总管 (CBD) 结石以及 CBD 结石留在原位的患者，胆囊切除术后需要内镜逆行胰胆管造影 (ERCP) 的风险尚不清楚。 方法数据取自 2009 年 1 月 1 日至 2019 年 12 月 10 日期间基于人群的瑞典胆结石手术和 ERCP 登记处。主要结果是术后 ERCP 残留 CBD 结石的风险。 结果总共纳入了 134 419 名接受胆囊切除术的患者，其中 2691 名患者（2.0%）随后因残留的 CBD 结石接受了 ERCP。当调整紧急或计划的胆囊切除术、提示 CBD 结石的术前症状、性别和年龄时，如果不进行 IOC，则 ERCP 的风险会增加（风险比 (HR) 1.4，95% CI 1.3 至 1.6）。如果通过监测来管理 IOC 发现的 CBD 结石，则 ERCP 的调整后风险也会增加（HR 5.5，95% CI 4.8 至 6.4）。即使对于无症状的小结石（小于 4 毫米），与干预组相比，监测组的 ERCP 调整风险也有所增加（HR 3.5，95% CI 2.4 至 5.1）。 结论IOC 加上去除胆囊切除术期间发现的 CBD 结石的干预措施与降低保留结石和计划外 ERCP 的风险相关，即使对于最小的无症状 CBD 结石也是如此。