胆囊切除术相关的胆管和血管胆道损伤。

Cholecystectomy-related bile duct and vasculobiliary injuries.

机构信息

North Western Hepatobiliary Unit, University Hospital Aintree, Liverpool L7 9AL, UK.

出版信息

Br J Surg. 2012 Aug;99(8):1129-36. doi: 10.1002/bjs.8806. Epub 2012 Jun 14.

DOI:10.1002/bjs.8806

PMID:22695869

Abstract

BACKGROUND

Combined vasculobiliary injury is a serious complication of cholecystectomy. This study examined medium- to long-term outcomes after such injury.

METHODS

Patients referred to this institution with Strasberg type E bile duct injuries were identified from a prospectively maintained database (1990-2010). Long-term outcomes were evaluated by chart review.

RESULTS

Sixty-three patients were referred with bile duct injury alone (45 patients) or vasculobiliary injury (18). Thirty patients (48 per cent) had septic complications before transfer. Twenty-six patients (41 per cent) had long-term biliary complications over a median follow-up of 96 (range 12-245) months. Nine patients (3 with bile duct injury, 6 with vasculobiliary injury) required further interventions after a median of 22 (8-38) months; five required biliary surgical revision and four percutaneous dilatation of biliary strictures. Vasculobiliary injury and injury-related sepsis were independent risk factors for treatment failure: hazard ratio 7·79 (95 per cent confidence interval 2·80 to 21·70; P < 0·001) and 4·82 (1·69 to 13·68; P = 0·003) respectively.

CONCLUSION

Outcome following bile duct injury repair was worse in patients with concomitant vasculobiliary injury and/or sepsis.

摘要

背景

合并肝胆管损伤是胆囊切除术的严重并发症。本研究旨在检查此类损伤后的中远期结果。

方法

从前瞻性维护的数据库（1990 年至 2010 年）中确定因 Strasberg 型 E 胆管损伤而转来本院的患者。通过病历回顾评估长期结果。

结果

63 例患者单独发生胆管损伤（45 例）或肝胆管损伤（18 例）。30 例患者（48%）在转来之前有感染性并发症。26 例患者（41%）在中位随访 96 个月（范围 12-245 个月）时发生长期胆道并发症。9 例患者（胆管损伤 3 例，肝胆管损伤 6 例）在中位 22 个月（8-38 个月）后需要进一步干预；5 例需要胆道手术修复，4 例需要经皮胆道狭窄扩张。肝胆管损伤和与损伤相关的感染是治疗失败的独立危险因素：风险比分别为 7.79（95%置信区间 2.80 至 21.70；P<0.001）和 4.82（1.69 至 13.68；P=0.003）。