Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit.
Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore.
Int J Surg. 2023 Jul 1;109(7):2120-2128. doi: 10.1097/JS9.0000000000000430.
Iatrogenic injury to the liver hilum during cholecystectomy is a severe surgical complication, with liver transplantation (LT) as the final drastic solution. The authors report the experience of our center and conduct a review of the literature on the outcomes of LT performed in this setting.
Data sources included MEDLINE, EMBASE, and CENTRAL from inception to 19 June 2022. Studies reporting on patients treated with LT for liver hilar injuries following cholecystectomy were included. Incidence, clinical outcomes, and survival data were synthesized through a narrative review.
Twenty-seven articles were identified, including 213 patients. Eleven (40.7%) articles highlighted deaths within 90-days post-LT. Post-LT mortality was reported in 28 (13.1%) patients. Severe complications (≥Clavien III) occurred in at least 25.8% ( n =55) of patients. Within larger cohorts, 1-year overall survival (OS) was 76.5-84.3%, and 5-year OS was 67.2-83.0%. The authors also highlight our own experience managing 14 patients with liver hilar injury secondary to cholecystectomy, of which two required LT.
While short-term morbidity and mortality is significant, available long-term data suggests reasonable OS in these patients following LT. Future studies are necessary to better understand the relationship between different types of liver hilar injury, transplant indication, and outcomes of LT in this setting.
胆囊切除术时医源性肝门损伤是一种严重的手术并发症，最终可能需要进行肝移植（LT）。作者报告了本中心的经验，并对该情况下行 LT 的文献进行了回顾。
数据来源包括 MEDLINE、EMBASE 和 CENTRAL，检索时间从建库至 2022 年 6 月 19 日。纳入报告了因胆囊切除术后肝门损伤而行 LT 治疗的患者的研究。通过叙述性综述综合了发病率、临床结局和生存数据。
共确定了 27 篇文章，包括 213 例患者。11 篇（40.7%）文章强调了 LT 后 90 天内的死亡情况。报告了 28 例（13.1%）患者的 LT 后死亡率。至少有 25.8%（ n =55）的患者发生严重并发症（≥Clavien III 级）。在更大的队列中，1 年总生存率（OS）为 76.5-84.3%，5 年 OS 为 67.2-83.0%。作者还强调了本中心管理 14 例继发于胆囊切除术的肝门损伤患者的经验，其中 2 例需要 LT。
虽然短期发病率和死亡率较高，但现有长期数据表明，这些患者在 LT 后 OS 情况尚可。未来的研究有必要更好地了解不同类型的肝门损伤、移植适应证与该情况下 LT 结局之间的关系。
