Nordin Arno, Halme Leena, Mäkisalo Heikki, Isoniemi Helena, Höckerstedt Krister
Transplantation and Liver Surgery Unit, Helsinki University Hospital, Helsinki, Finland.
Liver Transpl. 2002 Nov;8(11):1036-43. doi: 10.1053/jlts.2002.35557.
Laparoscopic cholecystectomy is associated with a higher rate of bile duct injuries than an open cholecystectomy. The annual incidence of bile duct injuries has remained almost constant and these injuries tend to be more serious, making demands on the method of repair. We wanted to report the management and outcome of major bile duct injuries after laparoscopic cholecystectomy in patients referred to a hepatobiliary and liver transplantation unit. Eighteen patients (14 women), with a median age of 53.5 years were referred to the liver surgery unit with a major bile duct injury after laparoscopic cholecystectomy. The injury was identified after a median of 3 days (range, 0 to 25 days) after operation and the median time interval to referral was 79 days (0 to 2270 days). Fourteen patients had undergone surgery before referral. By the time of referral, four patients had developed end-stage cirrhosis, necessitating liver transplantation. Three of them had undergone bilioenteric drainage operations at the referring institute. Of the remaining 14 patients, three were managed by therapeutic endoscopic procedures. Ten patients were managed with Roux-en-Y hepaticojejunostomy. One died of septic complications before the repair. A median time for hospitalization in our unit was 33 days (range, 10 to 164 days). At present, 16 patients are alive. One patient died of Kaposi's sarcoma 7 months after liver transplantation. A long interval between bile duct injury and referral was associated with the development of end-stage liver disease. Surgery of biliary lesions is demanding, and surgical experience with multidisciplinary approach, including therapeutic endoscopy and liver transplantation, is necessary for successful outcome.
与开腹胆囊切除术相比，腹腔镜胆囊切除术导致胆管损伤的发生率更高。胆管损伤的年发生率几乎保持不变，而且这些损伤往往更严重，这对修复方法提出了要求。我们想报告在一家肝胆及肝移植科就诊的患者，腹腔镜胆囊切除术后发生主要胆管损伤的处理方法及结果。18例患者（14例女性），中位年龄53.5岁，因腹腔镜胆囊切除术后发生主要胆管损伤被转诊至肝脏外科。损伤在术后中位3天（范围0至25天）被发现，转诊的中位时间间隔为79天（0至2270天）。14例患者在转诊前已接受手术。到转诊时，4例患者已发展为终末期肝硬化，需要进行肝移植。其中3例在转诊机构接受了胆肠引流手术。其余14例患者中，3例通过治疗性内镜手术处理。10例患者接受了Roux-en-Y肝空肠吻合术。1例在修复前死于感染性并发症。在我们科室住院的中位时间为33天（范围10至164天）。目前，16例患者存活。1例患者在肝移植后7个月死于卡波西肉瘤。胆管损伤与转诊之间的时间间隔较长与终末期肝病的发生有关。胆管病变的手术要求很高，对于成功的治疗结果，具备包括治疗性内镜和肝移植在内的多学科手术经验是必要的。
