Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Sección XVI, 14080, Tlalpan, Mexico City, México.
J Gastrointest Surg. 2021 Oct;25(10):2553-2561. doi: 10.1007/s11605-021-04934-1. Epub 2021 Feb 2.
Bile duct injury (BDI) is accompanied by significant morbidity and long-term impact in quality of life. Subtotal cholecystectomy (STC) is an alternative to prevent this outcome but is associated with other complications. The aim of this work is to demonstrate that BDI associated morbidity exceeds STC associated morbidity, underscoring STC as a reasonable bail out strategy.
We compared 115 patients who underwent STC with 293 patients who were referred to our center with BDI type E1-E3 and underwent surgical repair. The groups were comparable because in both instances the surgeon had the opportunity to decide not to perform a total cholecystectomy once critical view of safety (CVS) was not achieved.
Bile leakage was found in 21% of the STC group with only one BDI (0.9%). More Accordion ≥ 4 were found in the STC group (10.4% vs 4.8%, p = 0.035); however, reoperations were more frequent in the BDI group (8.2% vs 0.9%, p = 0.006). No patient in the STC group required reintervention for completion cholecystectomy. After 3.8 years follow-up, 2.4% of patients had secondary biliary cirrhosis in the BDI group; none in the STC group.
Despite complications of STC, morbidity associated with BDI is much higher due to high long-term reoperation rate, in addition to secondary biliary cirrhosis. STC is a safe alternative that can prevent BDI if properly and timely performed in the context of difficult cholecystectomy.
胆管损伤（BDI）伴随显著的发病率和长期生活质量影响。胆囊次全切除术（STC）是预防这种结果的一种替代方法，但也与其他并发症相关。本研究旨在证明BDI 相关发病率超过 STC 相关发病率，凸显 STC 作为一种合理的紧急救援策略。
我们比较了 115 例接受 STC 的患者和 293 例因 E1-E3 型 BDI 并接受手术修复而转至我们中心的患者。这两组是可比的，因为在这两种情况下，一旦未达到安全关键视图（CVS），外科医生都有机会决定不进行全胆囊切除术。
STC 组中有 21%发生胆漏，而 BDI 组中仅有 1 例（0.9%）。STC 组中发现更多的 Accordion ≥4（10.4%比 4.8%，p = 0.035）；然而，BDI 组的再次手术更为频繁（8.2%比 0.9%，p = 0.006）。STC 组无患者因完成胆囊切除术而需要再次干预。在 3.8 年的随访中，BDI 组中有 2.4%的患者发生继发性胆汁性肝硬化；STC 组中无患者发生。
尽管 STC 有并发症，但由于长期再次手术率高，除了继发性胆汁性肝硬化外，BDI 相关发病率更高。如果在困难的胆囊切除术背景下及时正确地进行，STC 是一种安全的替代方法，可以预防 BDI。
