Caputo L, Aitken D R, Mackett M C, Robles A E
Department of Surgery, Loma Linda University Medical Center, California 92354.
Am Surg. 1992 Dec;58(12):766-71.
Laparoscopic cholecystectomy has achieved wide acceptance as the preferred treatment for symptomatic gallbladder disease. Yet there are alarming reports of iatrogenic bile duct injuries. To establish a comparison standard, the incidence of iatrogenic bile duct injury during conventional cholecystectomy has to be known. A single institutional retrospective review of 1,617 consecutive open cholecystectomies between 1980 and 1989 was performed. Eight patients (0.49%) sustained iatrogenic bile duct injury in this study. Inflammation, anatomic variation, or both were contributing factors in all injuries. Operative cholangiography identified the injury at the initial operation in three patients. Treatment consisted of either primary ductal repair, ductal repair over a stent, or ductal-enteric anastomosis. There were no late complications after surgery (follow-up 26 to 97 months; mean 50.9 months). The implications for laparoscopic cholecystectomy are apparent. Iatrogenic bile duct injuries are associated with acute inflammation and/or variant ductal anatomy; routine operative cholangiography assumes increased importance; and immediate repair of the injury minimizes long-term complications.
腹腔镜胆囊切除术已被广泛接受为有症状胆囊疾病的首选治疗方法。然而，有令人担忧的关于医源性胆管损伤的报道。为了建立一个比较标准，必须了解传统胆囊切除术中医源性胆管损伤的发生率。对1980年至1989年间连续进行的1617例开腹胆囊切除术进行了单机构回顾性研究。本研究中有8例患者（0.49%）发生医源性胆管损伤。炎症、解剖变异或两者都是所有损伤的促成因素。术中胆管造影在3例患者的初次手术中发现了损伤。治疗包括一期胆管修复、支架置入后胆管修复或胆管-肠吻合术。术后无晚期并发症（随访26至97个月；平均50.9个月）。腹腔镜胆囊切除术的影响显而易见。医源性胆管损伤与急性炎症和/或胆管解剖变异有关；常规术中胆管造影的重要性增加；损伤的立即修复可将长期并发症降至最低。
