Miguel Angel Mercado, Ismael Domínguez, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", P.C.14000 México, DF, Mexico.
World J Gastrointest Surg. 2011 Apr 27;3(4):43-8. doi: 10.4240/wjgs.v3.i4.43.
To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases), GII- 2000-2004 (139 cases) and GIII- 2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment IV and V resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period. The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.
回顾胆管损伤患者的分类和一般治疗指南及其长期结果。在 20 年期间，510 例复杂环形损伤患者被转介到我们的团队在墨西哥城的国立医学与营养研究所“萨尔瓦多·祖比兰”医院进行修复，还有 198 例在其他地方（私人诊所）。对三级学术大学医院的记录进行了分析，并分为三个时间段：GI-1990-99（33 例）、GII-2000-2004（139 例）和 GIII-2004-2008（140 例）。所有患者均接受 Roux-en-Y 肝肠吻合术治疗。使用跨吻合支架的数量减少（78%比 2%，P=0.0001）。更多地进行部分第四段和第五段切除术（45%比 75%，P=0.2）（以获得高位胆肠吻合术）。手术死亡率（3%比 0.7%，P=0.09）、术后胆管炎（54%比 13%，P=0.0001）、吻合口狭窄（30%比 5%，P=0.0001）、短期和长期并发症以及需要再次手术（手术或放射）（45%比 11%，P=0.0001）在最后一个时间段显著减少。作者得出结论，向高容量中心的转变改善了胆管损伤修复的长期结果。即使是有兴趣和三级护理中心也有一个学习曲线。
