Department of Digestive Surgery, Bordeaux University Hospital, Pessac, France.
Department of Digestive Surgery, Bordeaux University Hospital, Pessac, France.
HPB (Oxford). 2022 Jan;24(1):94-100. doi: 10.1016/j.hpb.2021.08.817. Epub 2021 Aug 14.
Major bile duct injuries (BDI) following cholecystectomy require complex reconstructive surgery. The aim was to collect the liver transplantations (LT) performed in France for major BDI following cholecystectomy, to analyze the risk factors and to report the results.
National multicenter observational retrospective study. All the patients who underwent a LT in France between 1994 and 2017, for BDI following cholecystectomy, were included.
30 patients were included. 25 BDI occurred in non hepato-biliary expert centers, 20 were initially treated in these centers. Median time between injury and LT was 3 years in case of an associated vascular injury (11 injuries), versus 11.7 years without vascular injury (p = 0.006). Post-transplant morbidity rate was 86.7%, mortality 23.5% at 5 years.
Iatrogenic BDI remains a real concern with severe cases, associated with vascular damages or leading to cirrhosis, with no solution but LT. It is associated with high morbidity and not optimal results. This enlights the necessity of early referral of all major BDI in expert centers to prevent dramatic outcome. Decision to perform transplantation should be taken before dismal infectious situations or biliary cirrhosis and access to graft should be facilitated by Organ Sharing Organizations.
胆囊切除术后发生的主要胆管损伤 (BDI) 需要复杂的重建手术。本研究旨在收集法国因胆囊切除术后发生的主要 BDI 而行肝移植 (LT) 的病例，分析其相关风险因素并报告其结果。
这是一项全国多中心观察性回顾性研究。纳入 1994 年至 2017 年期间在法国因 BDI 而行 LT 的所有患者。
共纳入 30 例患者。25 例 BDI 发生于非肝胆专家中心，其中 20 例最初在这些中心接受治疗。伴有血管损伤的患者（11 例）从损伤到 LT 的中位时间为 3 年，无血管损伤的患者为 11.7 年（p=0.006）。移植后 5 年的发病率为 86.7%，死亡率为 23.5%。
医源性 BDI 仍然令人担忧，尤其是伴有血管损伤或导致肝硬化的严重病例，LT 是唯一的解决方案。它与高发病率和不理想的结果相关。这说明所有主要 BDI 都应尽早转至专家中心，以防止出现严重后果。在出现严重感染或胆汁性肝硬化之前，应做出移植决定，器官共享组织应促进获取供体。
