Mastoraki Aikaterini, Mastoraki Sotiria, Kriaras Ioannis, Douka Evangelia, Geroulanos Stefanos
Department of Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 17674 Athens, Greece.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1233-7.
BACKGROUND/AIMS: This study aimed to ascertain the frequency of biliary complications following cardiac surgery, to determine preoperative risk factors and to identify the significance of prompt diagnosis and institution of therapy.
All patients who underwent open-heart surgery (4588 patients) during a period of 3 years were examined prospectively for complications involving gall bladder and biliary tract. Patients with preoperative hepatic dysfunction or biliary disorders were excluded from this study.
Biliary complications occurred in 14 patients. Gangrene of gallbladder (n=5) and acute acalculous cholecystitis (n = 5) were the most common complications followed by distension of the common bile duct (n = 2), cholelithiasis (n = 1) and empyema (n = 1). The majority of complications presented within the 3rd postoperative week. Chole cystectomy was performed in 5 patients and percutaneous drainage of the gallbladder in 7. Mortality rate was 43%. Biliary complications correlated with advanced age, the male sex, combined surgical procedures, preoperative low cardiac output syndrome, prolonged bypass and aortic cross-clump time, mechanical ventilation, the usage of Intra-Aortic Balloon Pumping, multiple transfusions and the administration of inotrops.
Biliary complications after cardiac surgery are uncommon but life threatening and may result from hypoperfusion. Clinical features are often subtle, and a high index of suspicion is necessary for an early diagnosis and appropriate treatment.
背景/目的：本研究旨在确定心脏手术后胆系并发症的发生率，确定术前危险因素，并明确及时诊断和治疗的重要性。
对3年内接受心脏直视手术的所有患者（4588例）进行前瞻性检查，以了解涉及胆囊和胆道的并发症情况。术前有肝功能障碍或胆道疾病的患者被排除在本研究之外。
14例患者发生胆系并发症。胆囊坏疽（n = 5）和急性非结石性胆囊炎（n = 5）是最常见的并发症，其次是胆总管扩张（n = 2）、胆石症（n = 1）和积脓（n = 1）。大多数并发症在术后第3周内出现。5例患者行胆囊切除术，7例患者行经皮胆囊引流术。死亡率为43%。胆系并发症与高龄、男性、联合手术、术前低心排血量综合征、体外循环时间延长和主动脉阻断时间、机械通气、主动脉内球囊反搏的使用、多次输血及使用血管活性药物相关。
心脏手术后胆系并发症虽不常见，但危及生命，可能由灌注不足引起。临床特征往往不明显，早期诊断和恰当治疗需要高度的怀疑指数。
