Kakati Rasha T, Othman Mohamad, Kharroubi Hussein, Ataya Karim, Nassar Hussein, Hafez Bassel, Faraj Walid, Khalife Mohamad Jawad
Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Department of General Surgery, Faculty of Medicine and Medical Sciences, University of Balamand, Tripoli, Lebanon.
SAGE Open Med Case Rep. 2022 Aug 24;10:2050313X221119587. doi: 10.1177/2050313X221119587. eCollection 2022.
Injuries of the biliary tract and complex injuries involving vascular and parenchymal tissue can be detrimental despite the improved use of laparoscopy. Complex biliary injuries are variable depending on the type of injury as well as patient and surgeon factors. We present four cases of complex biliary injuries at our tertiary referral center with hepatobiliary expertise: biliary stenosis with obstruction, double duct system anatomy, combined right hepatic arterial transection and biliary duct injury, and a complete pedicle injury. Early identification and specialized repair of complex biliary injuries is essential to minimize patient morbidity. Notably, consulting a specialist intraoperatively in case of difficult dissection and visualization or a suspected injury and considering bail-out strategies such as a subtotal cholecystectomy or conversion are safe approaches to minimize complex biliary injuries. Earlier recognition and repair of complex biliary injuries improves outcomes when immediate intraoperative repair can be performed rather than delayed postoperatively.
尽管腹腔镜技术的应用有所改进，但胆道损伤以及涉及血管和实质组织的复杂损伤仍可能是有害的。复杂的胆道损伤因损伤类型以及患者和外科医生因素而异。我们在我们的三级转诊中心介绍了四例具有肝胆专业知识的复杂胆道损伤病例：伴有梗阻的胆管狭窄、双管系统解剖结构、右肝动脉横断合并胆管损伤以及完全蒂损伤。早期识别和专门修复复杂的胆道损伤对于将患者的发病率降至最低至关重要。值得注意的是，在解剖困难和视野不清或怀疑有损伤的情况下术中咨询专家，并考虑诸如次全胆囊切除术或中转开腹等补救策略，是将复杂胆道损伤降至最低的安全方法。当可以在术中立即进行修复而不是术后延迟修复时，早期识别和修复复杂的胆道损伤可改善预后。
