Department of Gastroenterological Surgery, Helsinki University Hospital, Helsinki University, Haartmaninkatu 4, 00290, Helsinki, Finland.
Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
Dig Dis Sci. 2018 Feb;63(2):474-480. doi: 10.1007/s10620-017-4768-7. Epub 2017 Sep 25.
Iatrogenic bile duct injury (BDI) is a common complication after cholecystectomy. Patients are mainly treated endoscopically, but the optimal treatment method has remained unclear.
The aim was to analyze endoscopic treatment in BDI after cholecystectomy and to explore endoscopic sphincterotomy (ES), with or without stenting, as the primary treatment for an Amsterdam type A bile leak.
All patients referred to Helsinki University Hospital endoscopy unit due to a suspected BDI between the years 2004 and 2014 were included in this retrospective study. To collect the data, all ERC reports were reviewed.
Of the 99 BDI patients, 94 (95%) had bile leak of whom 11 had concomitant stricture. Ninety-three percent of all patients were treated endoscopically. Seventy-one patients had native papillae and a leak in the cystic duct or peripheral radicals. They were treated with ES (ES group, n = 50) or with sphincterotomy and stenting (EST group, n = 21). There was no difference between the closure time of the fistula (p = 0.179), in the time of discharge from hospital (p = 0.298), or in the primary healing rate between the ES group and the EST group (45/50 vs 19/21 patients, p = 0.951).
After the right patient selection, the success rate of endoscopic treatment can approach 100% for Amsterdam type A bile leak. ES is an effective and cost-effective single procedure with success rate similar to EST. It may be considered as a first-line therapy for the management of Amsterdam type A leaks.
医源性胆管损伤（BDI）是胆囊切除术后的常见并发症。患者主要接受内镜治疗，但最佳治疗方法仍不清楚。
分析胆囊切除术后 BDI 的内镜治疗，并探讨内镜下括约肌切开术（ES）联合或不联合支架置入作为 Amsterdam 型 A 型胆漏的主要治疗方法。
本回顾性研究纳入了 2004 年至 2014 年间因疑似 BDI 而转至赫尔辛基大学医院内镜科的所有患者。为了收集数据，回顾了所有 ERC 报告。
99 例 BDI 患者中，94 例（95%）有胆漏，其中 11 例伴有狭窄。所有患者中有 93%接受了内镜治疗。71 例患者有原发性乳头，且胆漏位于胆囊管或周边分支。他们接受了 ES（ES 组，n=50）或括约肌切开术和支架置入（EST 组，n=21）治疗。两组患者瘘管闭合时间（p=0.179）、出院时间（p=0.298）或初次愈合率均无差异（45/50 例与 19/21 例患者，p=0.951）。
在正确选择患者后，Amsterdam 型 A 型胆漏的内镜治疗成功率可接近 100%。ES 是一种有效且具有成本效益的单一操作，其成功率与 EST 相似。它可作为 Amsterdam 型 A 型胆漏管理的一线治疗方法。
