Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Am Coll Surg. 2010 Oct;211(4):495-502. doi: 10.1016/j.jamcollsurg.2010.06.013.
Excellent results of surgical reconstruction of major bile duct injuries (BDIs) have been well-documented. Reports of successful definitive management of central bile duct leakage and stenoses have been reported infrequently. The aim of this study was to assess treatment and outcomes for operative and endoscopic treatment of BDI after laparoscopic cholecystectomy (LC) and define the role of endoscopy in management.
All patients undergoing treatment for post-laparoscopic BDI from 1998 to 2007 at Mayo Clinic, Rochester, Minnesota were reviewed. Outcomes of surgical and endoscopic intervention were analyzed.
BDI was identified in 159 patients (mean age 51 years). Injury was recognized intraoperatively in 39 (25%) patients. Primary intervention was surgical in 59 (37%) and endoscopic in 100 (63%) patients. Class A BDIs (n = 77) were successfully treated endoscopically in 76 (99%) patients. Seven had class D BDIs; 4 were managed surgically, and 3 endoscopically. Of 66 patients with E1 to E4 BDI, 44 (67%) were initially managed surgically and 22 (33%) endoscopically. Thirteen of the latter 22 underwent sustained endoscopic therapy (median stent time 7 months), which was successful in 10 (77%). Four patients with E5 were managed surgically. Median follow-up was 45 months. Sixty-three patients underwent Roux-en-Y hepaticojejunostomy reconstruction at Mayo; 3 (5%) failed and required stenting. None required operative revision.
Endoscopic management of class A BDI has excellent outcomes. Although surgical management remains the preferred therapy, short-term endoscopic treatment for class E1 to E4 can optimize the patient and operative field for reconstruction. Prolonged stenting in select patients with E1 to E4 characterized by stenosis is successful in the majority.
手术重建胆管损伤（BDI）的效果极佳，已有大量文献报道。但关于胆总管漏和狭窄的确定性治疗成功的报道较少。本研究旨在评估腹腔镜胆囊切除术（LC）后手术和内镜治疗 BDI 的治疗效果和结果，并确定内镜在治疗中的作用。
回顾了 1998 年至 2007 年明尼苏达州罗切斯特梅奥诊所接受治疗的所有腹腔镜 BDI 患者。分析了手术和内镜干预的结果。
159 例患者（平均年龄 51 岁）被诊断为 BDI。39 例（25%）患者术中发现损伤。59 例（37%）患者进行了初始手术干预，100 例（63%）患者进行了内镜治疗。77 例 A 类 BDI 患者经内镜成功治疗 76 例（99%）。7 例为 D 类 BDI，其中 4 例接受手术治疗，3 例接受内镜治疗。66 例 E1 至 E4 类 BDI 患者中，44 例（67%）最初接受手术治疗，22 例（33%）接受内镜治疗。22 例中的 13 例接受持续内镜治疗（中位支架时间 7 个月），10 例（77%）成功。4 例 E5 患者接受手术治疗。中位随访时间为 45 个月。63 例患者在梅奥接受 Roux-en-Y 肝肠吻合术重建；3 例（5%）失败并需要支架。无患者需要再次手术。
内镜治疗 A 类 BDI 效果极佳。虽然手术治疗仍然是首选，但对 E1 至 E4 类患者进行短期内镜治疗可以优化患者和手术野，为重建做好准备。在 E1 至 E4 类中，少数有狭窄的患者行长期支架治疗成功率较高。
