Salama Ibrahim Abdelkader, Shoreem Hany Abdelmeged, Saleh Sherif Mohamed, Hegazy Osama, Housseni Mohamed, Abbasy Mohamed, Badra Gamal, Ibrahim Tarek
Department of Hepatobiliary Surgery, National Liver Institute, Menophyia University, Shiben Elkom, Egypt.
Department of Radiology, National Liver Institute, Menophyia University, Shiben Elkom, Egypt.
HPB Surg. 2014;2014:575136. doi: 10.1155/2014/575136. Epub 2014 Nov 10.
Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center.
背景。医源性胆管损伤被认为是胆囊切除术中最严重的并发症。在专门中心处理的此类损伤病例显示出更好的治疗效果。目的。评估主要转诊肝胆中心对胆管损伤的处理情况。患者与方法。在埃及一家主要的肝胆中心，10年间对472例连续的胆囊切除术后胆管损伤患者采用多学科团队（肝胆外科医生、胃肠病学家和放射科医生）进行处理，其中232例患者采用内镜治疗，42例患者采用经皮技术，198例患者采用手术治疗。结果。内镜是232例（49%）轻度/中度胆漏（68%）和胆管狭窄（47%）患者非常成功的初始治疗方法，18例（3.8%）患者通过增加经皮（会师技术）治疗后成功率提高。然而，198例（42%）患者因主要胆管横断、结扎、大量胆漏和严重狭窄需要进行手术。62例患者需要紧急手术，136例患者需要择期手术。大多数病例采用肝空肠吻合术并放置经吻合口支架。术后有1例因胆源性败血症死亡，3例（1.5%）经皮扩张和支架置入治疗的患者出现术后狭窄。结论。多学科护理团队对胆管损伤的处理效果更好，从最初的微创技术到处理严重复杂损伤时的主要手术，鼓励尽早转诊至高度专业化的肝胆中心。
