Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
J Gastrointest Surg. 2010 Feb;14(2):344-51. doi: 10.1007/s11605-009-1087-0.
Injury to a segmental or sectoral bile duct is a rare event in laparoscopic cholecystectomy; its diagnosis and management may be difficult.
Between April 1998 and December 2006, 73 patients referred to the author's tertiary center for management of postcholecystectomy biliary complications were studied. The patients with segmental/sectoral bile duct injury were divided into two groups: injury to a duct which drains at least one Couinaud segment (type 1) or injury to a minor biliary radical in the gallbladder fossa (type 2). Beside the management of concomitant vascular or other biliary injury, type 1 segmental/sectoral duct injury was repaired by biliary-enteric anastomosis and type 2 by oversewing.
Ten out of 73 referred patients had segmental/sectoral duct injuries (eight type 1, two type 2). Despite multiple radiological imaging and endoscopic procedures, in seven patients, the lesion was identified only by precise surgical dissection. The median length of hospital treatment was 26 (range 9-47) days. One patient died due to sepsis before any definitive treatment. During the mean follow-up of 43 (range 27-111) months, seven patients remained asymptomatic while two patients developed biliary anastomotic strictures requiring intervention.
Segmental/sectoral duct injury is difficult to be assessed by conventional radiological diagnostics and should be taken into consideration in every case of bile leakage. Surgical treatment, adapted to the type of lesion, generally results in a favorable outcome.
腹腔镜胆囊切除术中损伤节段或扇段胆管是一种罕见的情况；其诊断和处理可能较为困难。
1998 年 4 月至 2006 年 12 月期间，作者的三级中心收治了 73 例因胆囊切除术后胆系并发症就诊的患者。将胆管节段/扇段损伤的患者分为两组：至少有一条 Couinaud 段引流的胆管损伤（1 型）或胆囊窝内小胆管残端损伤（2 型）。除处理合并的血管或其他胆管损伤外，1 型节段/扇段胆管损伤采用胆肠吻合修复，2 型采用修补缝合。
73 例转诊患者中有 10 例发生胆管节段/扇段损伤（8 例 1 型，2 例 2 型）。尽管进行了多次影像学和内镜检查，但在 7 例患者中，只有通过精确的手术解剖才能确定病变。中位住院治疗时间为 26 天（范围 9-47 天）。1 例患者在接受任何确定性治疗前因败血症死亡。在平均 43 个月（范围 27-111 个月）的随访中，7 例患者无症状，2 例患者发生胆肠吻合口狭窄需干预。
常规放射学诊断难以评估胆管节段/扇段损伤，应在每例胆漏患者中考虑到这种损伤。针对病变类型的手术治疗通常可获得良好的效果。
