Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom.
2nd Department of Propaedeutic Surgery, General Hospital Laiko, National and Kapodistrian University of Athens, Greece.
HPB (Oxford). 2023 Dec;25(12):1475-1481. doi: 10.1016/j.hpb.2023.08.004. Epub 2023 Aug 15.
Bile duct injury (BDI) is an infrequent but serious complication of cholecystectomy, often with life-changing consequences. Liver transplantation (LT) may be required following severe BDI, however given the rarity, few large studies exist to guide management for complex BDI.
A systematic review was performed to assess post-operative complications, 30-day mortality, retransplant rate and 1-year and 5-year survival following LT for BDI in Medline, EMBASE, Web of Science or Cochrane Clinical Trials Database.
Seven articles met inclusion criteria, describing 179 patients that underwent LT for BDI. Secondary biliary cirrhosis (SBC) was the main indication for LT (82.2% of patients). Median model for end-stage liver disease (MELD) scores at time of LT ranged from 16 to 20.5. Median 30-day mortality was 20.0%. The 1-year and 5-year survival ranges were 55.0-84.3% and 30.0-83.3% respectively, and the overall retransplant rate was 11.5%.
BDI is rarely indicated for LT, predominantly for SBC following multiple prior interventions. MELD scores poorly reflect underlying morbidity, and exception criteria for waitlisting may avoid prolonged LT waiting times. 30-day mortality was higher than for non-BDI indications, with comparable long term survival, suggesting that LT remains a viable but high risk salvage option for severe BDI.
胆管损伤（BDI）是胆囊切除术的一种罕见但严重的并发症，常导致生活发生重大改变。严重 BDI 可能需要进行肝移植（LT），但由于其罕见性，很少有大型研究来指导复杂 BDI 的管理。
系统检索了 Medline、EMBASE、Web of Science 或 Cochrane 临床试验数据库，以评估 LT 治疗 BDI 的术后并发症、30 天死亡率、再次移植率以及 1 年和 5 年生存率。
符合纳入标准的有 7 篇文章，描述了 179 例因 BDI 而行 LT 的患者。继发性胆汁性肝硬化（SBC）是 LT 的主要适应证（82.2%的患者）。LT 时中位终末期肝病模型（MELD）评分范围为 16 至 20.5。30 天死亡率的中位数为 20.0%。1 年和 5 年生存率范围分别为 55.0-84.3%和 30.0-83.3%，总体再次移植率为 11.5%。
BDI 很少需要 LT 治疗，主要用于多次先前干预后的 SBC。MELD 评分不能很好地反映潜在的发病率，等待名单的例外标准可能避免 LT 等待时间过长。30 天死亡率高于非 BDI 适应证，长期生存率相当，表明 LT 仍然是严重 BDI 的一种可行但高风险的挽救选择。
