Huang Qiang, Yao Han Hui, Shao Feng, Wang Chen, Hu Yuan Guo, Hu Sanyuan, Qiu Lu Jun
Department of General Surgery, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, 250012, China.
Dig Dis Sci. 2014 Dec;59(12):3085-91. doi: 10.1007/s10620-014-3255-7. Epub 2014 Jun 26.
Bile duct injury (BDI) after laparoscopic cholecystectomy (LC-BDI) is still a major problem. However, despite the many improvements in clinical management of patients undergoing repair, postoperative complications remain frequent and factors that increase the susceptibility to such adverse events remain unknown.
To report on a large experience with laparoscopic cholecystectomy-associated bile duct injuries (LC-BDIs) and define predictive factors associated with postoperative complication.
A retrospective medical record review of 94 patients referred for the surgical management of major BDIs to our center during a 12-year period between January 1, 1998, and December 31, 2010, was performed. Univariate statistical analysis and multivariate analysis were used to identify risk factors for postoperative complications. A nomogram was developed to predict postoperative complication, given associated risk factors, and bootstrap validation was performed.
In univariate analysis, there is no factor significantly associated with short-term complication. There was a statistically significant relationship between type of repair and the risk of biliary strictures (p = 0.012). Other factors significantly associated with late biliary strictures were sepsis (p = 0.007) and bile leak (p = 0.003). In multivariate analysis, bile leak (p = 0.005), sepsis (p = 0.03), and type of repair (p = 0.028) were independently and significantly associated with long-term complication. The resulting nomogram demonstrated good accuracy in predicting long-term complication, with a bootstrap-corrected concordance index 0.7905.
Our results suggest that missed injuries that result in sepsis or bile leak as well as high injuries that require hepaticojejunostomy will result in a higher stricture rate after repair.
腹腔镜胆囊切除术后胆管损伤（LC-BDI）仍是一个主要问题。然而，尽管在接受修复手术患者的临床管理方面有诸多改进，但术后并发症仍然频发，且增加此类不良事件易感性的因素仍不明确。
报告大量腹腔镜胆囊切除术相关胆管损伤（LC-BDIs）的经验，并确定与术后并发症相关的预测因素。
对1998年1月1日至2010年12月31日期间因主要胆管损伤被转诊至本中心接受手术治疗的94例患者的病历进行回顾性研究。采用单因素统计分析和多因素分析来确定术后并发症的危险因素。根据相关危险因素制定了预测术后并发症的列线图，并进行了自举验证。
在单因素分析中，没有因素与短期并发症显著相关。修复类型与胆管狭窄风险之间存在统计学显著关系（p = 0.012）。与晚期胆管狭窄显著相关的其他因素是败血症（p = 0.007）和胆漏（p = 0.003）。在多因素分析中，胆漏（p = 0.005）、败血症（p = 0.03）和修复类型（p = 0.028）与长期并发症独立且显著相关。所得列线图在预测长期并发症方面显示出良好的准确性，自举校正一致性指数为0.7905。
我们的结果表明，导致败血症或胆漏的漏诊损伤以及需要肝空肠吻合术的高位损伤在修复后会导致更高的狭窄率。
