Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Gut Liver. 2013 May;7(3):352-6. doi: 10.5009/gnl.2013.7.3.352. Epub 2013 May 13.
BACKGROUND/AIMS: This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks.
A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done.
One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analysis, female gender (p=0.02), open cholecystectomy as the index operation (p=0.0001), delay in the referral from identification of injury (p=0.04), persistence of an external biliary fistula (EBF) beyond 4 weeks (p=0.0001), EBF output >400 mL (p=0.01), presence of jaundice (p=0.0001), raised serum total bilirubin level (p=0.0001), raised serum alkaline phosphatase level (p=0.0001), and complete BDI (p=0.0001) were associated with the development of BBS. Furthermore, open cholecystectomy as the index operation (p=0.04), delayed referral (p=0.02), persistent EBF (p=0.03), and complete BDI (p=0.001) were found to predict patient outcome in the multivariate analysis.
For the majority of patients with BDI, the risk of developing BBS could have been predicted at the initial presentation.
背景/目的：本研究旨在确定在胆囊切除术后发生胆管损伤（BDI）并出现胆汁漏的患者中，与良性胆道狭窄（BBS）发展相关的因素。
回顾性分析了 1989 年 1 月至 2009 年 12 月期间我院收治的 214 例 BDI 患者。
153 例（71%）患者发生 BBS（I 组），61 例（29%）患者正常（II 组）。单因素分析显示，女性（p=0.02）、开腹胆囊切除术作为初始手术（p=0.0001）、损伤发现后延迟转诊（p=0.04）、外引流管持续存在超过 4 周（p=0.0001）、外引流管引流量>400 mL（p=0.01）、黄疸（p=0.0001）、血清总胆红素水平升高（p=0.0001）、血清碱性磷酸酶水平升高（p=0.0001）和完全性 BDI（p=0.0001）与 BBS 的发展相关。此外，开腹胆囊切除术作为初始手术（p=0.04）、延迟转诊（p=0.02）、持续存在外引流管（p=0.03）和完全性 BDI（p=0.001）在多因素分析中被发现可预测患者结局。
对于大多数 BDI 患者，在初次就诊时可能已经可以预测发生 BBS 的风险。
