Department of Surgical Gastroenterology, Medical College Hospital, Kolkata, West Bengal, India.
Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
Langenbecks Arch Surg. 2022 Dec;407(8):3525-3532. doi: 10.1007/s00423-022-02684-5. Epub 2022 Sep 22.
Bile duct injuries (BDIs) are the potential grievous complications of cholecystectomy that result in substantial morbidity and mortality. Outcomes of BDI management depend on multiple factors such as the type and extent of injury, timing of repair, and surgical expertise. The present retrospective study was conducted to analyse the risk factors associated with the BDI repair outcomes.
The data of patients having primary or recurrent bile duct stricture following BDI from 1985 to 2018 were retrospectively evaluated.
A total of 268 patients underwent hepaticojejunostomy (HJ). Of the total, 218 patients had primary bile duct stricture, and 50 patients had HJ stricture. The most commonly performed procedure for primary BDI was Roux-en-Y HJ (RYHJ), followed by right hepatectomy, right posterior sectionectomy, and left hepatectomy. All patients with strictured HJ underwent RYHJ, except one who underwent a right hepatectomy. Outcome assessment using the McDonald grading system showed that 62%, 27%, 5%, and 6% of patients with primary bile duct stricture had grade A, grade B, grade C, and grade D complications, respectively, with a mortality rate of 3.21%, whereas 46%, 34%, and 18% patients with strictured HJ had grade A, grade B, and grade C complications, respectively, with a mortality rate of 2%. High-up biliary strictures, early repair, and blood loss > 350 mL are the surrogate markers for failure of repair.
Management of BDI needs a multidisciplinary approach. The outcomes of both primary biliary stricture and strictured HJ can be improved with management of patients in a tertiary care centre. However, attempts to repair within 2 weeks of injury, Strasberg E and E, and blood loss of > 350 mL may have an adverse effect on the outcome of HJ.
胆管损伤（BDI）是胆囊切除术后潜在的严重并发症，可导致严重的发病率和死亡率。BDI 治疗结果取决于多种因素，如损伤类型和程度、修复时机以及手术专业知识。本回顾性研究旨在分析与 BDI 修复结果相关的危险因素。
回顾性分析 1985 年至 2018 年 BDI 后出现原发性或复发性胆管狭窄的患者数据。
共有 268 例患者行胆肠吻合术（HJ）。其中，218 例患者有原发性胆管狭窄，50 例患者有 HJ 狭窄。原发性 BDI 最常施行的手术是 Roux-en-Y HJ（RYHJ），其次是右肝切除术、右后叶切除术和左肝切除术。所有 HJ 狭窄患者均行 RYHJ 治疗，除 1 例患者行右肝切除术。采用 McDonald 分级系统进行疗效评估，结果显示原发性胆管狭窄患者中，62%、27%、5%和 6%分别为 A、B、C 和 D 级并发症，死亡率为 3.21%，而 HJ 狭窄患者中，46%、34%和 18%分别为 A、B 和 C 级并发症，死亡率为 2%。高位胆管狭窄、早期修复和出血量＞350ml 是修复失败的替代标志物。
BDI 的治疗需要多学科方法。在三级医疗中心对患者进行管理，可以改善原发性胆管狭窄和 HJ 狭窄的治疗结果。然而，在损伤后 2 周内进行修复、Strasberg E 和 E 分级以及出血量＞350ml 可能会对 HJ 的结果产生不利影响。
