Maddah Ghodratollah, Rajabi Mashhadi Mohammad Taghi, Parvizi Mashhadi Mehdi, Nooghabi Mehdi Jabbari, Hassanpour Masoumeh, Abdollahi Abbas
Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
J Surg Res. 2017 Jun 1;213:215-221. doi: 10.1016/j.jss.2015.11.032. Epub 2015 Nov 25.
Iatrogenic traumatic extrahepatic biliary tract injuries though rarely occur; they can lead to exceedingly morbid complications. The aim of this study was to evaluate the management strategies and outcomes of patients presented with iatrogenic bile duct injuries.
This is a retrospective study. Over 19 y, 124 patients were managed for iatrogenic biliary injuries at our institution. The data related to the etiology of biliary tract injury, symptoms of injury, laboratory and radiologic studies, injury-to-diagnosis time, type of biliary tract injury, injury management, hospitalization time, and postoperative complications were reviewed.
The main clinical presentations were jaundice or recurrent cholangitis in 64 (51.61%) patients, followed by bile peritonitis in 34 (56.67%) and biliary fistula in 26 (43.33%) patients. Only in 23 (18.54%) cases, the injury was recognized intraoperatively. The most frequent surgical procedure was open cholecystectomy in 81 (65.32%) of 124 patients. The remaining patients were operated on laparoscopically. Good results were achieved in 99 of 101 patients with direct suture repair including hepaticojejunostomy, choledocoduodenostomy, and choledochocholedochostomy (98.02% success rate) at the first attempt. Three cases (2.97%) of biliary strictures after direct suture technique and four (3.96%) cases of postoperative mortalities were detected. The mortality rate was mostly affected by male gender, advanced age, and existence of bile peritonitis. Totally, 111 (89.52%) patients are still alive with a mean follow-up time of 78 ± 38 (2-230) mo.
Biliary injuries can be sometimes life-threatening complications. A successful repair may provide patients with a lifelong relief from symptoms, whereas a failed repair may result in recurrent biliary obstruction, reoperation, and even death.
医源性创伤性肝外胆道损伤虽很少发生，但可导致极其严重的并发症。本研究的目的是评估医源性胆管损伤患者的治疗策略和结局。
这是一项回顾性研究。在19年期间，我院对124例医源性胆管损伤患者进行了治疗。回顾了与胆道损伤病因、损伤症状、实验室和影像学检查、损伤至诊断时间、胆道损伤类型、损伤处理、住院时间及术后并发症相关的数据。
主要临床表现为黄疸或复发性胆管炎64例（51.61%），其次为胆汁性腹膜炎34例（56.67%）和胆瘘26例（43.33%）。仅23例（18.54%）损伤在术中被发现。最常见的手术方式是124例患者中的81例（65.32%）行开腹胆囊切除术。其余患者行腹腔镜手术。101例行直接缝合修复（包括肝空肠吻合术、胆总管十二指肠吻合术和胆总管胆总管吻合术）的患者中，99例（成功率98.02%）首次尝试即取得良好效果。发现直接缝合技术后发生胆道狭窄3例（2.97%），术后死亡4例（3.96%）。死亡率主要受男性、高龄和胆汁性腹膜炎的影响。共有111例（89.52%）患者仍存活，平均随访时间为78±38（2 - 230）个月。
胆管损伤有时可能是危及生命的并发症。成功修复可使患者终身缓解症状，而修复失败可能导致复发性胆道梗阻、再次手术甚至死亡。
