Walsh R M, Henderson J M, Vogt D P, Mayes J T, Grundfest-Broniatowski S, Gagner M, Ponsky J L, Hermann R E
Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
J Gastrointest Surg. 1998 Sep-Oct;2(5):458-62. doi: 10.1016/s1091-255x(98)80037-1.
Bile duct injuries are a serious complication of cholecystectomy. Laparoscopic cholecystectomies (LC) were originally associated with an increased incidence of injuries. Patients referred to a tertiary center were reviewed to assess the trends in the number, presentation, and management. Seventy-three patients were referred over a 6-year period with a maximum of 17 patients referred in 1992, but the number has not declined substantially over time. The persistent number of referrals is a consequence of ongoing injuries. One third of injuries were diagnosed at LC, and the use of cholangiography has not increased. The number of cystic duct leaks has not decreased and they represent 25% of all cases. The level of injury has remained unchanged with Bismuth types I and II in 37% and types III and IV in 38%. Excluding patients with cystic duct leaks, 58% were referred after a failed ductal repair. Definitive treatment with biliary stenting was successful in 37%, and 34 patients (47%) required a biliary-enteric anastomosis. Complications occurred in 18 patients (25%) including seven with postoperative stricture or cholangitis. No biliary reoperations have been performed at a mean follow-up of 36 months.
胆管损伤是胆囊切除术的一种严重并发症。腹腔镜胆囊切除术（LC）最初与损伤发生率增加有关。对转诊至三级中心的患者进行了回顾，以评估损伤数量、表现及处理方式的变化趋势。在6年期间共转诊了73例患者，1992年转诊人数最多达17例，但随着时间推移，转诊人数并未大幅下降。持续有转诊病例是持续发生损伤的结果。三分之一的损伤在LC手术时被诊断出来，胆管造影术的使用并未增加。胆囊管漏的数量没有减少，占所有病例的25%。损伤程度保持不变，I型和II型损伤占37%，III型和IV型损伤占38%。排除胆囊管漏患者后，58%的患者是在胆管修复失败后转诊的。胆管支架置入的确定性治疗成功率为37%，34例患者（47%）需要进行胆肠吻合术。18例患者（25%）出现并发症，其中7例有术后狭窄或胆管炎。在平均36个月的随访期内未进行胆管再次手术。
