de Reuver P R, Busch O R C, Rauws E A, Lameris J S, van Gulik Th M, Gouma D J
Department of Surgery, Amsterdam Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
J Gastrointest Surg. 2007 Mar;11(3):296-302. doi: 10.1007/s11605-007-0087-1.
The management of a bile duct injury detected during laparoscopic cholecystectomy is still under discussion. An end-to-end anastomosis (with or without T-tube drainage) in peroperative detected bile duct injury has been reported to be associated with stricture formation of the anastomosis area and recurrent jaundice. Between 1991 and 2005, 56 of a total of 500 bile duct injury patients were referred for treating complications after a primary end-to-end anastomosis. After referral, 43 (77%) patients were initially treated endoscopically or by percutaneous transhepatic stent placement (n = 3; 5%). After a mean follow-up of 7 +/- 3.3 years, 37 patients (66%) were successfully treated with dilatation and endoscopically placed stents. One patient died due to a treatment-related complication. A total of 18 patients (32%) underwent a hepaticojejunostomy. Postoperative complications occurred in three patients (5%) without hospital mortality. These data confirm that end-to-end anastomosis might be considered as a primary treatment for peroperative detected transection of the bile duct without extensive tissue loss. Complications (stricture or leakage) can be adequately managed by endoscopic or percutaneous drainage the majority of patients (66%) and reconstructive surgery after complicated end-to-end anastomosis is a procedure with relative low morbidity and no mortality.
腹腔镜胆囊切除术中发现的胆管损伤的处理仍在讨论中。据报道，术中发现的胆管损伤行端端吻合术（带或不带T管引流）与吻合口狭窄形成和复发性黄疸有关。1991年至2005年期间，500例胆管损伤患者中有56例在初次端端吻合术后因并发症前来治疗。转诊后，43例（77%）患者最初接受内镜治疗或经皮经肝支架置入术（3例，5%）。平均随访7±3.3年后，37例（66%）患者通过扩张和内镜置入支架成功治疗。1例患者因治疗相关并发症死亡。共有18例（32%）患者接受了肝空肠吻合术。3例患者（5%）出现术后并发症，无医院死亡病例。这些数据证实，端端吻合术可被视为术中发现的无广泛组织损失的胆管横断的主要治疗方法。大多数患者（66%）的并发症（狭窄或渗漏）可通过内镜或经皮引流得到充分处理，复杂端端吻合术后的重建手术是一种发病率相对较低且无死亡率的手术。
