Balla Andrea, Quaresima Silvia, Corona Mario, Lucatelli Pierleone, Fiocca Fausto, Rossi Massimo, Bezzi Mario, Catalano Carlo, Salvatori Filippo M, Fingerhut Abe, Paganini Alessandro M
1 Department of General Surgery and Surgical Specialties "Paride Stefanini," Sapienza University of Rome , Rome, Italy .
2 Vascular and Interventional Radiology Unit, Department of Radiologic Sciences, Sapienza University of Rome , Rome, Italy .
J Laparoendosc Adv Surg Tech A. 2019 Feb;29(2):206-212. doi: 10.1089/lap.2018.0413. Epub 2018 Sep 25.
Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC.
From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed. Fifteen patients were managed by percutaneous transhepatic cholangiography (PTC)+endoscopic retrograde cholangiopancreatography (ERCP); five and six underwent PTC and ERCP alone, respectively. Median overall follow-up duration was 34 months. Three patients died from sepsis.
Out of 26 patients, 20 presented with main bile duct and six with nonmain bile duct injuries. Using the ATOM classification, every aspect of the BDI in every case was included, unlike with other classifications (Neuhaus, Lau, Strasberg, Bergman, and Hanover).
The all-inclusive European Association for Endoscopic Surgery (EAES) classification contains objective data and emphasizes the underlying mechanisms of damage, which is relevant for prevention. It also integrates vascular injury, necessary for ultimate management, and timing of discovery, which has diagnostic implications. The management complexity of these patients requires specialized referral centers.
胆管损伤（BDI）在腹腔镜胆囊切除术（LC）中更为常见。已有多种BDI分类方法被报道，但均未涵盖损伤的解剖结构和血管损伤（A）、发现时间（To）以及损伤机制（M）。本研究旨在将ATOM分类应用于一系列因LC术后BDI而转诊进行治疗的患者。
2008年至2016年，观察了26例胆管损伤患者（男性16例，女性10例，中位年龄63岁，范围34 - 82岁）。15例患者接受了经皮经肝胆管造影（PTC）+内镜逆行胰胆管造影（ERCP）治疗；5例和6例患者分别单独接受了PTC和ERCP治疗。中位总随访时间为34个月。3例患者死于败血症。
26例患者中，20例为主要胆管损伤，6例为非主要胆管损伤。与其他分类方法（Neuhaus、Lau、Strasberg、Bergman和Hanover）不同，使用ATOM分类法涵盖了每个病例中BDI的各个方面。
全面的欧洲内镜外科学会（EAES）分类包含客观数据，并强调损伤的潜在机制，这对预防具有重要意义。它还整合了最终治疗所必需的血管损伤以及具有诊断意义的发现时间。这些患者的治疗复杂性需要专门的转诊中心。
