Shetty Sushruth, Desai Premal R, Vora Hasmukh B, Bhavsar Mahendra S, Khiria Lakshman S, Yadav Ajay, Jillawar Nikhil
Department of Gastro Surgery, NHLM Medical College, Vadilal Sarabhai Hospital, Ahmedabad, Gujarat, India.
Niger J Surg. 2019 Jan-Jun;25(1):91-96. doi: 10.4103/njs.NJS_35_18.
Management of injuries sustained during cholecystectomy requires expertise and involves a patient who is troubled, usually drained of personal resources. There has been an increase in incidence with laparoscopic cholecystectomy. The standard surgical management done for major biliary injuries is Roux-en-Y Hepaticojejunostomy (R-en-Y HJ).
Patients managed surgically for definitive management of biliary injuries in the form of R-en-Y HJ were included. Data were collected from prospectively maintained records and through outpatient follow-up. Demographic data, early and late surgical complications, long-term outcomes, and follow-up results were analyzed.
Among the 62 patients, 26 were males, with a mean age of 37.4 ± 13.5 years. A total of 24 patients presented with ongoing biliary fistula. The Strasberg-Bismuth type of injury included types E1 in 8 (13%), E2 in 31 (50%), E3 in 19 (30.6%), and E4 in four patients (6.4%). There were no postoperative mortality and morbidity in 27.4% of patients. Atrophy-hypertrophy complex was seen in four patients, vascular injury in six patients, and an internal fistulisation with duodenum in two patients. Presence of comorbidities ( = 0.05), male gender ( = 0.03), tobacco use ( = 0.04), low albumin ( = 0.016), and more proximal (E4-E1) type of injury ( = 0.008) were independent predictors of postoperative morbidity ( < 0.05). The mean duration of patient follow-up was 26.2 ± 21.1 months.
Optimization of preoperative nutrition, avoidance of intraoperative blood transfusion, proper timing of repair, and tension-free R-en-Y HJ draining all the ducts which is done at an experienced hepatobiliary center provide the best outcome.
胆囊切除术期间所受损伤的处理需要专业知识，且涉及一名通常已耗尽个人资源且陷入困境的患者。腹腔镜胆囊切除术的发病率有所上升。针对主要胆管损伤的标准手术处理方法是 Roux-en-Y 肝空肠吻合术（R-en-Y HJ）。
纳入接受以 R-en-Y HJ 形式进行胆管损伤确定性手术处理的患者。数据从前瞻性保存的记录以及门诊随访中收集。分析人口统计学数据、早期和晚期手术并发症、长期结局以及随访结果。
62 例患者中，男性 26 例，平均年龄 37.4 ± 13.5 岁。共有 24 例患者存在持续性胆瘘。Strasberg-Bismuth 损伤类型包括 E1 型 8 例（13%）、E2 型 31 例（50%）、E3 型 19 例（30.6%）以及 E4 型 4 例（6.4%）。27.4%的患者无术后死亡率和发病率。4 例患者出现萎缩-肥大复合体，6 例患者出现血管损伤，2 例患者出现与十二指肠的内瘘形成。合并症（P = 0.05）、男性性别（P = 0.03）、吸烟（P = 0.04）、低白蛋白（P = 0.016）以及更靠近近端（E4 - E1）的损伤类型（P = 0.008）是术后发病的独立预测因素（P < 0.05）。患者的平均随访时间为 26.2 ± 21.1 个月。
术前营养优化、避免术中输血、恰当的修复时机以及在经验丰富的肝胆中心进行无张力的 R-en-Y HJ 引流所有胆管可提供最佳结局。
