肝部分切除术后并发中央胆管损伤的危险因素。

Risk factors for central bile duct injury complicating partial liver resection.

机构信息

Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.

出版信息

Br J Surg. 2012 Feb;99(2):256-62. doi: 10.1002/bjs.7802. Epub 2011 Dec 20.

DOI:10.1002/bjs.7802

PMID:22190220

Abstract

BACKGROUND

Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct, right or left hepatic duct. This study analysed the incidence, risk factors and consequences of CBDI in liver resection.

METHODS

Patients undergoing liver resection between 1990 and 2007 were included in this study. Those having resection for bile duct-related pathology or trauma, or after liver transplantation were excluded. Characteristics and outcome variables were collected prospectively and analysed retrospectively.

RESULTS

There were 19 instances of CBDI in 462 liver resections (4·1 per cent). One-third of patients with CBDI required surgical reintervention and construction of a hepaticojejunostomy. Resection type (P < 0·001), previous liver resection (P = 0·039) and intraoperative blood loss (P = 0·002) were associated with an increased risk of CBDI. Of all resection types, extended left hemihepatectomy was associated with the highest incidence of CBDI (2 of 9 procedures).

CONCLUSION

Patients undergoing extended left hemihepatectomy or repeat hepatectomy were at increased risk of CBDI.

摘要

背景

胆管损伤是肝切除术后的一种严重并发症。很少有研究对小周边胆管漏与中央胆管损伤（CBDI）进行区分，CBDI 定义为导致胆总管、肝总管、右或左肝管漏或狭窄的损伤。本研究分析了肝切除术后 CBDI 的发生率、危险因素和后果。

方法

本研究纳入了 1990 年至 2007 年间接受肝切除术的患者。排除了因胆管相关病变或创伤、或肝移植而接受肝切除术的患者。前瞻性收集特征和结局变量，并进行回顾性分析。

结果

在 462 例肝切除术中，有 19 例发生 CBDI（4.1%）。三分之一的 CBDI 患者需要再次手术干预和胆肠吻合术。CBDI 的发生与肝切除类型（P < 0·001）、既往肝切除术（P = 0·039）和术中出血量（P = 0·002）有关。在所有肝切除类型中，扩大左半肝切除术与 CBDI 的发生率最高（9 例中有 2 例）。