Department of Surgery, University the Witwatersrand, Johannesburg, South Africa; Department of Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of KwaZulu Natal, Durban, South Africa.
Department of Surgery, University of Auckland, Auckland, New Zealand.
Injury. 2022 Jan;53(1):98-102. doi: 10.1016/j.injury.2021.07.034. Epub 2021 Jul 30.
Gallbladder trauma is a rare injury. This study aimed to describe the significance of these injuries and the appropriate management strategies.
A retrospective study was undertaken at a major trauma centre in South Africa and included all patients diagnosed with a gallbladder injury between January 2012 and October 2020.
A total of 51 cases were included (88% male, mean age: 38 years), with 44 (86%) penetrating trauma cases [28 stab wounds (SW), 16 sustained gunshot wounds (GSW)]. Of the 7 (13%) blunt trauma cases, five were involved in a motor vehicle crash, and two were injured via assault. All patients underwent laparotomy. Full-thickness gallbladder laceration or perforation was the most common type of injury (84%) and all patients with a gallbladder perforation or laceration had a cholecystectomy at index operation. Two out of 5 patients with a gallbladder contusion were managed conservatively without a cholecystectomy and the remaining three had evidence of gallbladder necrosis which were managed with cholecystectomy. Associated extrahepatic bile duct injuries occurred in 4% of cases, and 18 cases (35%) required intensive care unit (ICU) admission. The overall mortality was 8%.
Gallbladder injury is rare but when encountered implies a significant degree of trauma. Although cholecystectomy is usually definitive, there is an association with other occult extra-hepatic biliary tract injuries. The severity of the associated injuries usually determines patient outcomes.
胆囊创伤较为罕见。本研究旨在描述这些损伤的意义和适当的管理策略。
本研究在南非一家大型创伤中心进行了回顾性研究，纳入了 2012 年 1 月至 2020 年 10 月期间所有被诊断为胆囊损伤的患者。
共纳入 51 例患者（88%为男性，平均年龄 38 岁），其中 44 例（86%）为穿透性创伤[28 例刺伤（SW），16 例枪伤（GSW）]。7 例（13%）为钝性创伤，5 例与机动车事故有关，2 例与袭击有关。所有患者均接受了剖腹手术。全层胆囊撕裂或穿孔是最常见的损伤类型（84%），所有胆囊穿孔或撕裂伤患者在初次手术时均行胆囊切除术。5 例胆囊挫伤者中有 2 例保守治疗，未行胆囊切除术，其余 3 例有胆囊坏死证据，行胆囊切除术。4%的病例发生肝外胆管损伤，18 例（35%）需要入住重症监护病房（ICU）。总的死亡率为 8%。
胆囊损伤较为罕见，但一旦发生，提示有严重的创伤。虽然胆囊切除术通常是明确的治疗方法，但与其他隐匿性肝外胆管损伤有关。相关损伤的严重程度通常决定患者的预后。
