医源性胆道损伤再手术时机对预后的影响

The influence of timing of definitive operation on prognosis of patients with iatrogenic bile duct injury

目的探讨医源性胆道损伤修复时机对患者预后的影响。方法回顾性分析外院转入（31例）及本院发生的（7例）医源性胆道损伤38例临床资料。全组病例均通过分析既往胆道手术史、术后病情变化、再次手术前的影像学表现和术中所见而最终确诊。根据实施确定性胆道修复手术的时间，将患者分为：术中修复（n=26）、早期修复（72h以内，n=15）和延迟修复（n=17）三组进行比较。结果胆道损伤发生后，术中修复患者的近期及远期治疗效果最佳，住院时间最短，医疗费用最少；早期修复次之。然而，能否及时发现胆道损伤、及时施行确定性的修复手术，受术者及所在医院胆道外科的水平所限。结论医源性胆道损伤的修复时机及正确处理是影响患者预后的决定性因素，最好术中及时发现及时修复，修复手术应由经验丰富的胆道外科医师实施。

Objective To investigate the influence of timing of definitive operation on prognosis of patients with iatrogenic bile duct injury （IBDI）. Methods The clinical data of 38 patients with IBDI were retrospectively analyzed. Of the 38 patients, the injury happened in 7 patients in our hospital while 31 patients were transferred in from other hospitals. We analyzed the previous operative records, the clinical manifestations of the patients, the radiological images and our operative findings in the definitive operations. According to the timing of the definitive operation, the patients were divided into the intraoperative repair group （n= 26）, the early repair group （n= 15） and the delayed repair group （n=17）. Results Patients in the intraoperative repair group had the best short-and long-term results, the shortest length of hospital stay and the lowest total cost. The early repair group, though having worse Results than the intraoperative repair group was still better than the delayed repair group. However, early detection of injuries and the ability to carry out timely corrective procedures depended on the availability of surgical expertise in the hospital. Conclusions The timing of definitive operation to provide corrective surgery to IBDI was a vitally important factor which affected prognosis. It is best to repair the injury within the same operation. The repair should be carried out by a doctor with ample experience in bile duct surgery.