Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia Antipolis, Nice, France.
HPB (Oxford). 2013 Aug;15(8):611-6. doi: 10.1111/hpb.12024. Epub 2012 Dec 27.
Bile duct injuries (BDIs) sustained during a cholecystectomy still remain a major surgical problem, and it is still not clear whether the injury should be repaired immediately or a delayed repair is preferred.
A retrospective national French survey was conducted to compare the results of immediate (at time of cholecystectomy), early (within 45 days after a cholecystectomy) and late (beyond 45 days after a cholecystectomy) surgical repair for BDI sustained during a cholecystectomy.
Forty-seven surgical centres provided 640 cases of bile duct injury sustained during a cholecystectomy of which 543 were analysed for the purpose of the present study. The timing of repair was immediate in 194 cases (35.7%), early in 216 cases (39.8%) and late in 133 cases (24.5%). The type of repair was a suture repair in 157 cases (81%), and a bilio-digestive reconstruction in 37 cases (19%) for immediate repair; a suture repair in 119 cases (55.1%) and a bilio-digestive anastomosis in 96 cases (44.9%) for the early repair; and a bilio-digestive reconstruction in 129 cases (97%) and a suture repair in 4 cases (3%) for late repair. A second procedure was required in 110 cases (56.7%) for immediate repair, 80 cases (40.7%) for early repair (P < 0.05) and in 9 cases (6.8%) for late repair (P < 0.001).
The timing of surgical repair for a bile duct injury sustained during a cholecystectomy influences significantly the rate of a second procedure and a late repair should be preferred option.
胆囊切除术时发生的胆管损伤仍然是一个主要的外科问题，目前仍不清楚是否应立即修复损伤，还是更倾向于延迟修复。
对法国全国范围内的一项回顾性调查进行了分析，比较了胆囊切除术后立即（在胆囊切除术中）、早期（胆囊切除术后 45 天内）和晚期（胆囊切除术后 45 天以上）进行外科修复对胆管损伤的效果。
47 家外科中心提供了 640 例胆囊切除术中胆管损伤的病例，其中 543 例用于本研究。修复时机为立即修复 194 例（35.7%），早期修复 216 例（39.8%），晚期修复 133 例（24.5%）。即时修复采用缝合修复 157 例（81%），胆汁消化重建 37 例（19%）；早期修复采用缝合修复 119 例（55.1%），胆汁消化吻合 96 例（44.9%）；晚期修复采用胆汁消化重建 129 例（97%），缝合修复 4 例（3%）。即时修复需要进行第二次手术 110 例（56.7%），早期修复 80 例（40.7%）（P < 0.05），晚期修复 9 例（6.8%）（P < 0.001）。
胆囊切除术后胆管损伤的修复时机显著影响第二次手术的发生率，因此应优先选择晚期修复。
