Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan.
J Int Med Res. 2023 Mar;51(3):3000605231162444. doi: 10.1177/03000605231162444.
Long-term results of hepaticojejunostomy (HJ) for complex bile duct injury (BDI) remain under-reported. The objective of this study was to assess short-term and long-term outcomes of HJ for post-cholecystectomy BDI.
This was a retrospective cohort study and included patients who underwent Roux-en-Y HJ for BDI (n = 87). Short-term (90-day) and long-term morbidity and mortality were assessed.
At presentation, 42 (48.2%) patients had E3 or E4 BDI, 27 (31%) patients had vascular injury, and liver resection was performed in 12 (13.7%) patients. The 90-day morbidity was 51.7% (n = 45), and the 90-day mortality was 2.3% (n = 2). The long-term mortality was 3.4% (n = 3). The 10-year estimated stricture-free survival was 95%. The 10-year estimated overall survival rate was 100% in patients who underwent major hepatectomy and 91% in patients who did not. The 10-year estimated overall survival rate was 100% in patients with vasculobiliary injury and was not reached in patients without vascular injury.
Vascular injury with proximal BDI is not uncommon. Excellent long-term outcomes might be achieved with Roux-en-Y HJ for BDI with vascular injury and in patients requiring liver resection.
肝肠吻合术（HJ）治疗复杂胆管损伤（BDI）的长期结果报道较少。本研究旨在评估胆囊切除术后 BDI 行 HJ 的短期和长期结果。
这是一项回顾性队列研究，纳入了因 BDI 行 Roux-en-Y HJ 的患者（n=87）。评估了短期（90 天）和长期发病率和死亡率。
就诊时，42 例（48.2%）患者为 E3 或 E4 BDI，27 例（31%）患者有血管损伤，12 例（13.7%）患者行肝切除术。90 天发病率为 51.7%（n=45），90 天死亡率为 2.3%（n=2）。长期死亡率为 3.4%（n=3）。10 年无狭窄生存率估计为 95%。行肝切除术的患者 10 年估计总生存率为 100%，未行肝切除术的患者为 91%。有血管胆管损伤的患者 10 年估计总生存率为 100%，无血管损伤的患者未达到该生存率。
近端 BDI 合并血管损伤并不少见。对于血管损伤和需要肝切除术的 BDI 患者，行 Roux-en-Y HJ 可获得良好的长期结果。
