Consultant Surgeon, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom,
Emeritus Professor of Surgery, Catholic University, Rome, Italy.
Dig Surg. 2021;38(2):91-103. doi: 10.1159/000512176. Epub 2020 Dec 16.
Biliary injuries during cholecystectomy represent serious adverse events that can have a profound impact on the patient's quality of life and on the surgeon's well-being and career. Sometimes, they can have an unexpectedly disastrous effect on the whole community, as demonstrated by the case of Anthony Eden, former foreign secretary and prime minister of Britain in the 1950s. Mr. Eden, later Lord Avon, had been suffering from biliary symptoms for a while when he had his cholecystectomy performed on April 12, 1953. On post-op day 1, a bile leak was evident, possibly due to a complete transection of the common bile duct. After a first reoperation to drain a bile collection, the definitive repair was performed in Boston by Dr. Cattell on June 10, 1953, with a loop hepatico-jejunostomy. Unfortunately, the bilioenteric anastomosis became gradually narrow, causing recurrent cholangitis, and Mr. Eden started a symptomatic treatment with pethidine, barbiturate, and amphetamine. These could have affected his perception of reality and his political judgement during the Suez Canal Crisis and, other than being the ultimate reason for 3,000+ war casualties, might have caused a Third World War. The historical and clinical implications of this case are thoroughly discussed.
胆囊切除术过程中的胆管损伤是严重的不良事件，会对患者的生活质量以及外科医生的身心健康和职业生涯产生深远影响。有时，它们可能会对整个社区产生意想不到的灾难性影响，正如 20 世纪 50 年代英国前外交大臣和首相安东尼·艾登的案例所证明的那样。艾登先生，后来的亚芬勋爵，在 1953 年 4 月 12 日接受胆囊切除术时已经出现了一段时间的胆管症状。术后第 1 天，出现了胆汁漏，可能是由于胆总管完全横断。第一次手术后进行了引流胆汁收集的操作，1953 年 6 月 10 日，由卡特尔医生在波士顿进行了确定性修复，采用肝肠环式吻合术。不幸的是，胆肠吻合口逐渐变窄，导致反复发作的胆管炎，艾登先生开始接受哌替啶、巴比妥类药物和安非他命的对症治疗。这些可能影响了他在苏伊士运河危机期间对现实的认知和政治判断，除了造成 3000 多名战争伤亡的最终原因外，还可能引发第三次世界大战。对该案例的历史和临床意义进行了深入讨论。
