Department of Hepatopancreatobiliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
Department of Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
Updates Surg. 2023 Oct;75(7):1911-1917. doi: 10.1007/s13304-023-01565-w. Epub 2023 Jun 24.
Iatrogenic bile duct injury remains the most severe complication of gallbladder surgeries. To reduce post-operation complication, we introduce an improved approach for bile duct injury repairment, named transhepatic percutaneous cholangial drainage (TPCD) which combined with end-to-end biliary anastomosis. Clinical data obtained from 12 patients between February 2012 and May 2022 were retrospectively analyzed. Patient demographic, clinical, operative, and follow-up data were analyzed using descriptive statistics. All injuries were repaired successfully and no fatal cases occurred. The mean operative time and hospital stay duration were 367.5 ± 103.2 min and 11.3 ± 3.5 days, respectively. In two cases (16.7%), bile leakage occurred at the bile duct anastomosis site. Three patients (25.0%) developed low-grade fever and one patient (8.3%) developed a postoperative infection of the incision site. No postoperative bleeding or bile duct strictures occurred in any of the cases. The patients were followed up from 12 to 122 months (median, 70.5 months). No cholangitis or bile duct restenosis was observed after biliary drainage tube removal. There were no long-term bile duct-related complications seen in the follow-up time. It is safe and feasible for TPCD combined with end-to-end biliary anastomosis using in bile duct injury.
医源性胆管损伤仍是胆囊手术最严重的并发症。为了减少术后并发症，我们引入了一种改良的胆管损伤修复方法，即经皮经肝胆管引流（TPCD）联合端端胆管吻合术。回顾性分析 2012 年 2 月至 2022 年 5 月期间 12 例患者的临床资料。采用描述性统计学方法对患者的人口统计学、临床、手术和随访资料进行分析。所有损伤均成功修复，无死亡病例。平均手术时间和住院时间分别为 367.5±103.2min 和 11.3±3.5d。在 2 例（16.7%）患者中，胆管吻合口处发生胆漏。3 例（25.0%）患者出现低热，1 例（8.3%）患者出现切口感染。无术后出血或胆管狭窄。患者随访 12~122 个月（中位数 70.5 个月）。拔除胆管引流管后，无胆管炎或胆管再狭窄。在随访期间，未观察到与胆管相关的长期并发症。TPCD 联合端端胆管吻合术用于胆管损伤是安全可行的。
