医源性胆管损伤行胆管空肠吻合术后近远期疗效分析  

Short-term and long-term results of hepaticojejunostomy for iatrogenic bile duct injury

作　　者：陈江明[1] 颜锡洋 薛鸿 陈子祥 赵义军[1] 谢坤[1] 刘付宝[1] 耿小平[1] CHEN Jiang-ming;YAN Xi-yang;XUE Hong(Department of Hepato-Pancreatico-Biliary Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230088,China)

机构地区：[1]安徽医科大学第一附属医院普外科(高新院区肝胆胰外科),安徽合肥230088

出　　处：《中国实用外科杂志》2020年第5期568-571,576,共5页Chinese Journal of Practical Surgery

基　　金：安徽省科技攻关项目(No.1804h0820239)。

摘　　要：目的探讨医源性胆管损伤行胆管空肠吻合术近远期疗效及影响疗效的主要危险因素。方法回顾性分析2004年1月至2018年12月安徽医科大学第一附属医院接诊胆囊切除术医源性胆管损伤行胆管空肠Rouxen-Y吻合术(HJ)36例病人临床资料。术后近期并发症采用Clavien-Dindo评分系统进行分级评价,远期疗效按Terblanche分级进行分级评价。单因素及多因素分析TerblancheⅣ级病人的高危因素。结果36例病人,8例(22.2%)病人出现Clavien-DindoⅢ级以上的近期并发症。中位随访时间为117个月(IQR 49~156个月)。远期随访疗效Terblanche分级显示:Ⅰ、Ⅱ级21例(58.3%);Ⅲ级6例(16.7%)间断性胆管炎发作保守治疗;Ⅳ级9例(25.0%)吻合口狭窄或结石形成伴胆管炎均接受再次手术治疗。吻合口狭窄或结石形成伴胆管炎的中位时间为24个月(IQR 12~60个月)。单因素分析显示,术前存在脓毒症、转诊前修复、围手术期Clavien-DindoⅢ级以上并发症和术后住院时间≥15 d与术后胆管狭窄或胆管结石形成伴胆管炎显著相关。多因素分析显示,术前存在脓毒症、转诊前修复和高位损伤(Stresberger分型E3-E5)是术后发生胆管狭窄或胆管结石形成伴胆管炎的独立危险因素。结论医源性胆管损伤可行HJ进行修复,损伤后由经验丰富的肝胆外科专科医师手术修复及术前感染控制是保证病人近期和远期疗效的重要条件。Objective To evaluate efficacy of hepaticojejunostomy for iatrogenic bile duct injury and the main risk factors affecting the effect.Methods The clinical data of 36 patients of hepaticojejunostomy for iatrogenic bile duct injury admitted from January 2004 to December 2018 in the Department of Hepato-Pancreatico-Biliary Surgery of the First Affiliated Hospital of Anhui Medical University were analyzed retrospectively.Clavien-Dindo classification was used for graded evaluation of short-term postoperative complications.Terblanche classification was used to evaluate the efficacy of patients at follow-up.Univariate and multivariate analysis were used to analyze the high-risk factors of TerblancheⅣpatients.Results Among 36 patients,8 patients(22.2%)had short-term complications of Clavien-Dindo gradeⅢor higher.The median follow-up time was 117 months(IQR 49-156 months).Long-term follow-up results showed that 21 patients(58.3%)of Terblanche gradeⅠandⅡ,6 patients(16.7%)of Terblanche gradeⅢwith intermittent cholangitis received conservative treatment,9 patients(25.0%)of Terblanche gradeⅣwith bile duct stricture or calculi accompanied with cholangitis were treated with reoperation.The median time to formation of bile duct stricture or calculi with bile duct inflammation was 24 months(IQR 12-60 months).Univariate analysis showed that sepsis before surgery,repair before referral,complications of Clavien-Dindo grade≥Ⅲand postoperative hospital stay≥15d were significantly associated with postoperative bile duct stricture or bile duct stones with cholangitis.Multivariate analysis showed that sepsis before surgery,repair before referral and high injury(Stresberger E3-E5)were independent risk factors for postoperative bile duct stricture or bile duct stones with cholangitis.Conclusion Hepaticojejunostomy can be performed for iatrogenic bile duct injury.After the injury,surgical repair by experienced specialist hepatobiliary surgeons and preoperative infection control are important conditions to to ensure the shor

关 键 词：医源性胆管损伤 胆管空肠ROUX-EN-Y吻合术 吻合口狭窄 

分 类 号：R6[医药卫生—外科学]