Colombo North Center for Liver Diseases, Department of Surgery, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P.O. Box 6, Ragama, Sri Lanka.
Colombo North Center for Liver Diseases, Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
BMC Gastroenterol. 2024 Nov 18;24(1):413. doi: 10.1186/s12876-024-03505-3.
Iatrogenic bile duct injuries (BDI) are a devastating complication. Long-term impact of corrective hepaticojejunostomy (HJ) for such injuries on post -surgery liver stiffness is lacking. Hence the aim of this study was to explore the extent of hepatic fibrosis in a cohort of patients with Strasberg E bile duct injuries who underwent HJ after a minimum follow-up of six months.
Out of 50 BDI presented over a period of 10-years, 19 patients with Strasberg type E, injuries that underwent HJ and completed a minimum 6-month follow-up [65.5 (7 -108)] period were selected. Data were prospectively collected on liver functions and liver stiffness was assessed using a Fibroscan. Their liver stiffness and degree of fibrosis was compared with (n = 38) age, gender and comorbidity matched controls.
The median age was 47 (30-70) years, with 63% females. Primary HJ was performed in 84%, with a median time from injury to HJ of 7 (1-39) days. The total bilirubin was 16.5 (11.2) µmol/L, Alkaline Phosphatase was 102 (27.2) U/L, and Platelet count was 256 (77) x 10. Liver stiffness (median 6.4 kPa) did not significantly differ from controls (5.3 kPa). Fibrosis assessment revealed comparable distribution of F0 to F3 fibrosis between the study and control groups (F0/F1: 68.4% vs. 84.4%, F2: 10.5% vs. 9.4%). However, all three patients with right hepatic artery injury (p = 0.003) and three of five patients with bile duct stricture had F3/F4 fibrosis.
Major BDI repair demonstrates comparable liver fibrosis in the absence of artery injury and anastomotic strictures. Measuring liver fibrosis could be valuable in the presence of arterial injuries or anastomotic strictures.
医源性胆管损伤（BDI）是一种破坏性的并发症。对于此类损伤进行矫正性胆肠吻合术（HJ）后对术后肝脏硬度的长期影响尚不清楚。因此，本研究的目的是探讨至少随访 6 个月后接受 HJ 的 Strasberg E 胆管损伤患者队列中肝纤维化的程度。
在 10 年期间出现的 50 例 BDI 中，选择了 19 例 Strasberg 型 E 损伤患者，这些患者接受了 HJ 并完成了至少 6 个月的随访[65.5（7-108）]。前瞻性收集了肝功能数据，并使用 Fibroscan 评估了肝脏硬度。将他们的肝脏硬度和纤维化程度与（n=38）年龄、性别和合并症相匹配的对照组进行比较。
中位年龄为 47（30-70）岁，女性占 63%。84%的患者行初次 HJ，从损伤到 HJ 的中位时间为 7（1-39）天。总胆红素为 16.5（11.2）µmol/L，碱性磷酸酶为 102（27.2）U/L，血小板计数为 256（77）×10。肝脏硬度（中位数 6.4kPa）与对照组无显著差异（5.3kPa）。纤维化评估显示研究组和对照组之间 F0 至 F3 纤维化的分布相似（F0/F1：68.4%比 84.4%，F2：10.5%比 9.4%）。然而，所有 3 例肝右动脉损伤患者（p=0.003）和 5 例胆管狭窄患者中的 3 例均有 F3/F4 纤维化。
主要的 BDI 修复术在没有动脉损伤和吻合口狭窄的情况下表现出相似的肝纤维化。在存在动脉损伤或吻合口狭窄的情况下，测量肝纤维化可能具有价值。
