Chaudhary Adarsh, Chandra Abhijit, Negi Sanjay S, Sachdev Ajay
Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital, New Delhi, India.
Dig Surg. 2002;19(1):22-7. doi: 10.1159/000052001.
Surgical repair for a postcholecystectomy bile duct injury can be complicated by the development of an anastomotic stricture which necessitates re-intervention. The authors reviewed their experience with patients requiring re-operation after unsuccessful surgical repair of the bile duct injury, to analyze the possible causes of the failure of the operative procedure and the long-term outcome following revisional surgery.
Retrospective analysis of the records of 41 patients referred to a tertiary care center for the management of recurrent stricture following surgical repair performed for a postcholecystectomy bile duct injury.
Before referral, 69 operative procedures had been performed on these 41 patients. Factors likely to be associated with increased chances of failure of the biliary reconstructive procedures included presentation with cholangitis after the biliary injury, no cholangiographic study before the surgical repair and surgical intervention within 3 weeks of the injury. Thirty-seven (90%) patients were found to have strictures at or above the level of confluence of right and left hepatic ducts, while at the time of the index repair only 12 (29%) patients had an injury at that level. Revisional surgery in all the patients was a Roux-en-Y hepaticojejunostomy. One patient died, 2 patients with multiple previous operations developed recurrence and needed intervention again. Over a mean follow-up period of 4.2 years, 90% patients had a satisfactory outcome.
Development of recurrent stricture following surgical repair of a postcholecystectomy biliary injury can be related to the technique and timing of the surgical procedure, the complication may therefore be avoidable in some patients. In experienced hands the results of revisional surgery are good but are adversely affected as the number of previous repairs increases.
胆囊切除术后胆管损伤的手术修复可能会因吻合口狭窄的发生而变得复杂，这就需要再次干预。作者回顾了他们对胆管损伤手术修复失败后需要再次手术的患者的治疗经验，以分析手术失败的可能原因以及翻修手术后的长期结果。
对41例因胆囊切除术后胆管损伤进行手术修复后出现复发性狭窄而转诊至三级医疗中心的患者的记录进行回顾性分析。
在转诊前，对这41例患者进行了69次手术。可能与胆管重建手术失败几率增加相关的因素包括胆管损伤后出现胆管炎、手术修复前未进行胆管造影检查以及在损伤后3周内进行手术干预。发现37例（90%）患者在左右肝管汇合处或其上方存在狭窄，而在初次修复时只有12例（29%）患者在该水平存在损伤。所有患者的翻修手术均为Roux-en-Y肝空肠吻合术。1例患者死亡，2例曾接受多次手术的患者出现复发并需要再次干预。在平均4.2年的随访期内，90%的患者预后良好。
胆囊切除术后胆管损伤手术修复后复发性狭窄的发生可能与手术技术和时机有关，因此在某些患者中这种并发症可能是可以避免的。在经验丰富的医生手中，翻修手术的效果良好，但随着先前修复次数的增加会受到不利影响。
