Jones-Monahan K, Gruenberg J C
Department of Surgery, Saginaw Cooperative Hospitals, Inc., Michigan, USA.
Am Surg. 1998 Jul;64(7):638-42.
Reports of bile duct injuries are from tertiary care institutions and, therefore, may not report the spectrum of management that these patients receive in the care of these injuries. From June 14,1990 (the first operation) to June 30, 1995, 2654 laparoscopic cholecystectomies (LCs) were reviewed at this community hospital medical center to determine risk factors contributing to the etiology of these injuries, time and symptoms at presentation, duration of illness, and management of these injuries. None of the 13 general surgeons practicing during this time period had laparoscopic training in a general surgical residency. There were six major bile duct injuries (0.25%), of which five were available for further review. All occurred in women with cholelithiasis and chronic cholecystitis. Two operations were routine and two were associated with biliary tract anomalies. In two patients, the injuries were detected at LCs and definitive biliary-enteric anastomoses were performed immediately. Three patients presented at 2, 15, and 42 days after LC. In two patients, one or more operative procedures were performed before definitive repair and these patients were referred to tertiary care centers. One patient was managed with sequential CT-guided drainage catheters after attempted closure of the defect. The length of illness for these five patients was 8, 69, 348, 402, and 435 days with a follow-up of 245, 345, 531, 575, and 1088 days. Laparoscopic experience before injury by the operating surgeon was 3, 26, 35, 77, and 333 operations. Major biliary tract injuries occurred during routine cholecystectomy, length of illness was substantial for most patients, and biliary-enteric anastomosis was definitive for four of the five patients. The operating surgeons' "learning curve" did not seem as important as in other studies.
胆管损伤的报告来自三级医疗机构，因此可能未涵盖这些患者在损伤处理过程中所接受的全部治疗情况。从1990年6月14日（首例手术）至1995年6月30日，在这家社区医院医疗中心对2654例腹腔镜胆囊切除术（LC）进行了回顾，以确定导致这些损伤病因的危险因素、就诊时的时间和症状、病程以及这些损伤的处理方式。在此期间执业的13位普通外科医生均未在普通外科住院医师培训中接受过腹腔镜培训。发生了6例主要胆管损伤（0.25%），其中5例可供进一步评估。所有损伤均发生在患有胆石症和慢性胆囊炎的女性患者中。2例手术为常规手术，2例与胆道异常有关。2例患者在LC术中发现损伤并立即进行了确定性胆肠吻合术。3例患者在LC术后2天、15天和42天就诊。2例患者在进行确定性修复前接受了一次或多次手术操作，并被转诊至三级医疗机构。1例患者在尝试闭合缺损后采用了序贯CT引导下引流导管进行处理。这5例患者的病程分别为8天、69天、348天、402天和435天，随访时间分别为245天、345天、531天、575天和1088天。手术医生在受伤前的腹腔镜手术经验分别为3例、26例、35例、77例和333例。主要胆道损伤发生在常规胆囊切除术中，大多数患者病程较长，5例患者中有4例行确定性胆肠吻合术。手术医生的“学习曲线”似乎不像其他研究中那么重要。
