Tekant Yaman, Serin Kürşat Rahmi, İbiş Abdil Cem, Ekiz Feza, Baygül Arzu, Özden İlgin
Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Hepatopancreatobiliary Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Surgeon. 2023 Feb;21(1):e32-e41. doi: 10.1016/j.surge.2022.03.003. Epub 2022 Mar 20.
A single-institution retrospective analysis was undertaken to assess long-term results of definitive surgical reconstruction for major bile duct injuries and risk factors for restenosis.
Patients treated between January 1995 and October 2020 were reviewed retrospectively. The primary outcome measure was patency.
Of 417 patients referred to a tertiary center, 290 (69.5%) underwent surgical reconstruction; mostly in the form of a hepaticojejunostomy (n = 281, 96.8%). Major liver resection was undertaken in 18 patients (6.2%). There were 7 postoperative deaths (2.4%). Patency was achieved in 97.4% of primary repairs and 88.8% of re-repairs. Primary patency at three months (including postoperative deaths and stents removed afterwards) in primary repairs was significantly higher than secondary patency attained during the same period in re-repairs (89.3% vs 76.5%, p < 0.01). The actuarial primary patency was also significantly higher compared to the actuarial secondary patency 10 years after reconstruction (86.7% vs 70.4%, p = 0.001). Vascular disruption was the only independent predictor of loss of patency after reconstruction (OR 7.09, 95% CI 3.45-14.49, p < 0.001), showing interaction with injuries at or above the biliary bifurcation (OR 9.52, 95% CI 2.56-33.33, p < 0.001).
Long-term outcome of surgical reconstruction for major bile duct injuries was superior in primary repairs compared to re-repairs. Concomitant vascular injury was independently associated with loss of patency requiring revision.
进行了一项单中心回顾性分析，以评估主要胆管损伤确定性手术重建的长期结果及再狭窄的危险因素。
回顾性分析1995年1月至2020年10月期间接受治疗的患者。主要结局指标为通畅情况。
在转诊至三级中心的417例患者中，290例（69.5%）接受了手术重建；大多数为肝空肠吻合术（n = 281，96.8%）。18例患者（6.2%）进行了 major 肝切除术。术后死亡7例（2.4%）。初次修复的通畅率为97.4%，再次修复的通畅率为88.8%。初次修复术后三个月的初次通畅率（包括术后死亡及随后取出支架的情况）显著高于同期再次修复的二次通畅率（89.3% 对76.5%，p < 0.01）。重建后10年的精算初次通畅率也显著高于精算二次通畅率（86.7% 对70.4%，p = 0.001）。血管损伤是重建后通畅性丧失的唯一独立预测因素（OR 7.09，95% CI 3.45 - 14.49，p < 0.001），显示与胆管分叉处或以上的损伤存在交互作用（OR 9.52，95% CI 2.56 - 33.33，p < 0.001）。
主要胆管损伤手术重建的长期结果在初次修复中优于再次修复。伴发的血管损伤与需要再次手术的通畅性丧失独立相关。
