Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
Br J Surg. 2014 Jan;101(2):63-8. doi: 10.1002/bjs.9349. Epub 2013 Dec 9.
Bile duct injury (BDI) after cholecystectomy is a serious complication. In a small subset of patients with BDI, failure of surgical or non-surgical management might lead to acute or chronic liver failure. The aim of this study was to review the indications and outcome of liver transplantation (LT) for BDI after open and laparoscopic cholecystectomy.
Patients with BDI after cholecystectomy who were on the waiting list for LT between January 1987 and December 2010 were identified from LT centres in Spain. A standardized questionnaire was sent to each unit for extraction of data on diagnosis, previous treatments, indication and outcome of LT for BDI.
Some 27 patients with BDI after cholecystectomy in whom surgical and non-surgical management for BDI failed were scheduled for LT over the 24-year interval. Emergency LT for acute liver failure was indicated in seven patients, all after laparoscopic cholecystectomy. Two patients died while on the waiting list and only one patient survived more than 30 days after LT. Elective LT for secondary biliary cirrhosis after a failed hepaticojejunostomy was performed in 13 patients after open and seven after laparoscopic cholecystectomy. One patient from the elective transplantation group died within 30 days of LT. The estimated 5-year overall survival rate was 68 per cent.
Emergency LT for acute liver failure was more common in patients with BDI after laparoscopic cholecystectomy, and associated with a poor outcome.
胆囊切除术后胆管损伤（BDI）是一种严重的并发症。在一小部分 BDI 患者中，手术或非手术治疗的失败可能导致急性或慢性肝功能衰竭。本研究旨在回顾因开腹和腹腔镜胆囊切除术导致的 BDI 患者接受肝移植（LT）的适应证和结果。
从 1987 年 1 月至 2010 年 12 月，西班牙各 LT 中心确定了胆囊切除术后发生 BDI 并在 LT 等待名单上的患者。向每个单位发送一份标准化问卷，以提取有关 BDI 的诊断、既往治疗、LT 适应证和结果的数据。
在 24 年的时间里，有 27 例因胆囊切除术后 BDI 而行手术和非手术治疗失败的患者计划接受 LT。7 例因急性肝功能衰竭而行急诊 LT，均为腹腔镜胆囊切除术后。2 例患者在等待名单上死亡，仅 1 例患者在 LT 后存活超过 30 天。13 例因开放和 7 例因腹腔镜胆囊切除术而行肝肠吻合术失败后继发胆汁性肝硬化而行择期 LT。择期移植组有 1 例患者在 LT 后 30 天内死亡。估计 5 年总生存率为 68%。
腹腔镜胆囊切除术后 BDI 患者更常见因急性肝功能衰竭而行急诊 LT，且预后不良。
