Topal B, Aerts R, Penninckx F
Department of Abdominal Surgery, University Clinic Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Surg Endosc. 1999 Jan;13(1):53-6. doi: 10.1007/s004649900897.
Concern has been expressed regarding the increased rates of biliary tract injury (BTI) at laparoscopic cholecystectomy. The aim of the present investigation was to analyze the outcome of laparoscopic biliary tract injury with leakage.
Sixteen patients having major laparoscopic BTI with leakage were treated. Thirteen of them were referred to our institution for further treatment. The follow-up was complete and focused on clinical outcome and biochemical analysis.
Eight BTI were identified at the time of laparoscopic cholecystectomy, and the procedure was converted to a laparotomy. In eight additional patients, BTI was recognized postoperatively. In this group one patient died because of lately diagnosed biliary peritonitis, whereas in the seven surviving patients nine attempts to repair the BTI and eight other interventions were performed. In the conversion group 14 attempts to repair the BTI and 11 other interventions were needed to completely solve the problems. Final restoration of the BTI was done by Roux-en-Y hepaticojejunostomy in 11 patients and suture repair with T-tube drainage of the bile duct in 4. During a median follow-up time of 63 months, three patients suffered from recurrent segmental cholangitis. In the other patients, neither clinical nor biochemical evidence of biliary disease has been found up to this writing.
Laparoscopic BTI has a high morbidity and mortality rate that seems comparable to BTI at open cholecystectomy. The number of attempts to repair the BTI as well as additional interventions is too high, but in this patient series the final outcome seemed to be similar after BTI recognized during and after laparoscopic cholecystectomy.
腹腔镜胆囊切除术中胆道损伤（BTI）发生率上升已引起关注。本研究旨在分析伴有渗漏的腹腔镜胆道损伤的治疗结果。
对16例发生严重腹腔镜BTI并伴有渗漏的患者进行了治疗。其中13例被转至我院接受进一步治疗。随访完整，重点关注临床结果和生化分析。
8例BTI在腹腔镜胆囊切除术中被发现，手术转为开腹手术。另外8例患者在术后被诊断为BTI。该组中有1例患者因晚期诊断的胆汁性腹膜炎死亡，而在7例存活患者中，进行了9次BTI修复尝试和8次其他干预。在中转开腹组中，为完全解决问题需要进行14次BTI修复尝试和11次其他干预。11例患者最终通过Roux-en-Y肝空肠吻合术修复BTI，4例通过胆管T管引流缝合修复。在中位随访时间63个月期间，3例患者发生复发性节段性胆管炎。在其他患者中，截至撰写本文时，未发现胆道疾病的临床或生化证据。
腹腔镜BTI的发病率和死亡率较高，似乎与开腹胆囊切除术中的BTI相当。BTI修复尝试次数和其他干预次数过多，但在本患者系列中，腹腔镜胆囊切除术中及术后发现BTI后的最终结果似乎相似。
