Vincenzi Paolo, Mocchegiani Federico, Nicolini Daniele, Benedetti Cacciaguerra Andrea, Gaudenzi Diletta, Vivarelli Marco
Division of HPB and Abdominal Transplant Surgery, Department of Gastroenterology and Transplants, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy.
Division of HPB and Abdominal Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy.
J Clin Med. 2024 Aug 16;13(16):4837. doi: 10.3390/jcm13164837.
: Post-cholecystectomy bile duct injuries (BDIs) represent a challenging complication, with negative impacts on clinical outcomes. Several surgical and endoscopic/interventional radiologist (IR) approaches have been proposed to manage these damages, though with high failure rates. This individual patient data (IPD) systematic review analyzes the potential risk factors for failure after treatment interventions for BDIs, both surgical and endoscopic/IR. : An extensive literature search was conducted on MEDLINE and Scopus for relevant articles published in English on the management of BDIs after cholecystectomy, between 1 January 2010 and 31 December 2023. Our series of BDIs was included. BDIs were always categorized according to the Strasberg's classification. The composite primary endpoints evaluated were the failure of treatment interventions, defined as patient death or the requirement of any other procedure, whatever surgical and/or endoscopic/IR, after the primary treatment. : A total of 342 cases were retrieved from our literature analysis, including our series of 19 patients. Among these, three groups were identified: "upfront surgery", "upfront endoscopy and/or IR" and "no upfront treatment", consisting of 224, 109 and 9 patients, respectively. After eliminating the third group, treatment intervention failure was observed overall in 34.2% (114/333) of patients, of whom 80.7% (92/114) and 19.3% (22/114) in the "upfront surgery" and in the "upfront endoscopy/IR" groups, respectively. At multivariable analysis, injury type D and E, and repair in a non-specialized center represented independent predictors of treatment failure in both groups, whereas laparoscopic cholecystectomy (LC) converted to open and immediate attempt of surgical repair exclusively in the first group. : Significant treatment failure rates are responsible for remarkable negative effects on immediate and longer-term clinical outcomes of post-cholecystectomy BDIs. Understanding the important risk factors for this outcome may better guide the most appropriate therapeutical approach and improve clinical decisions in case this serious complication occurs.
胆囊切除术后胆管损伤（BDIs）是一种具有挑战性的并发症，会对临床结局产生负面影响。虽然提出了几种手术和内镜/介入放射科医生（IR）的方法来处理这些损伤，但失败率很高。这项个体患者数据（IPD）系统评价分析了BDIs治疗干预后失败的潜在风险因素，包括手术和内镜/IR治疗。
在MEDLINE和Scopus上进行了广泛的文献检索，以查找2010年1月1日至2023年12月31日期间以英文发表的关于胆囊切除术后BDIs管理的相关文章。纳入了我们的BDIs系列病例。BDIs总是根据Strasberg分类进行分类。评估的复合主要终点是治疗干预失败，定义为患者死亡或在初次治疗后需要进行任何其他手术，无论是手术和/或内镜/IR手术。
通过文献分析共检索到342例病例，包括我们的19例患者系列。其中，确定了三组：“直接手术”、“直接内镜和/或IR治疗”和“无直接治疗”，分别由224例、109例和9例患者组成。排除第三组后，总体上34.2%（114/333）的患者出现治疗干预失败，其中“直接手术”组和“直接内镜/IR治疗”组分别为80.7%（92/114）和19.3%（22/114）。在多变量分析中，D型和E型损伤以及在非专科中心进行修复是两组治疗失败的独立预测因素，而在第一组中腹腔镜胆囊切除术（LC）转为开放手术并立即尝试手术修复。
显著的治疗失败率对胆囊切除术后BDIs的近期和长期临床结局产生了显著的负面影响。了解这一结果的重要风险因素可能会更好地指导最合适的治疗方法，并在发生这种严重并发症时改善临床决策。
