Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Moliere, 67098, Strasbourg, France.
World J Surg. 2013 Mar;37(3):573-81. doi: 10.1007/s00268-012-1847-y.
Repeat repair of bile duct injuries (BDIs) after cholecystectomy is technically challenging, and its success remains uncertain. We retrospectively evaluated the short- and long-term outcomes of patients requiring reoperative surgery for BDI at a major referral center for hepatobiliary surgery.
Between January 1991 and May 2011, we performed surgical BDI repairs in 46 patients. Among them, 22 patients had undergone a previous surgical repair elsewhere (group 1), and 24 patients had no previous repair (group 2). We compared the early and late outcomes in the two groups.
The patients in group 1 were younger (48.6 vs. 54.8 years, p = 0.0001) and were referred after a longer interval (>1 month) from BDI (72.7 vs. 41.7%, p = 0.042). Intraoperative diagnosis of BDI (59.1 vs. 12.5%, p = 0.001), ongoing cholangitis (45.4 vs. 12.5%; p = 0.02), and delay of repair after referral to our institution (116 ± 34 days vs. 23 ± 9 days; p = 0.001) were significantly more frequent in group 1 than in group 2. No significant differences were found for postoperative mortality, morbidity, or length of stay between the groups. Patients with associated vascular injuries had a higher postoperative morbidity rate (p = 0.01) and associated hepatectomy rate (p = 0.045). After a mean follow-up of 96.6 ± 9.7 months (range 5-237.2 months, median 96 months), the rate of recurrent cholangitis (6.5%) was comparable in the two groups.
This study demonstrates that short- and long-term outcomes after surgical repair of BDI are comparable regardless of whether the patient requires reoperative surgery for a failed primary repair. Associated vascular injuries increase postoperative morbidity and the need for liver resection.
胆囊切除术后胆管损伤（BDI）的重复修复在技术上具有挑战性，其成功率仍不确定。我们回顾性评估了在肝胆外科主要转诊中心因 BDI 而需要再次手术的患者的短期和长期结果。
1991 年 1 月至 2011 年 5 月，我们对 46 例患者进行了手术 BDI 修复。其中，22 例患者曾在其他地方接受过手术修复（第 1 组），24 例患者未接受过修复（第 2 组）。我们比较了两组的早期和晚期结果。
第 1 组患者年龄较小（48.6 岁比 54.8 岁，p=0.0001），BDI 后就诊间隔时间较长（>1 个月，72.7%比 41.7%，p=0.042）。术中诊断为 BDI（59.1%比 12.5%，p=0.001）、持续胆管炎（45.4%比 12.5%；p=0.02）以及转诊至我院后修复时间延迟（116±34 天比 23±9 天；p=0.001）在第 1 组中明显更为常见。两组间术后死亡率、发病率或住院时间无显著差异。伴有血管损伤的患者术后发病率较高（p=0.01），肝切除术率也较高（p=0.045）。平均随访 96.6±9.7 个月（范围 5-237.2 个月，中位数 96 个月）后，两组复发性胆管炎发生率（6.5%）相似。
本研究表明，BDI 手术修复后的短期和长期结果在是否需要再次手术修复初次修复失败方面无差异。伴有血管损伤会增加术后发病率和肝切除的需要。
