胆囊切除术后胆管损伤不同治疗方式的疗效分析

Analysis of different treatment methods for bile duct injury after cholecystectomy

目的探究不同治疗方式在同一分型医源性胆管损伤(IBDI)中的临床疗效。方法回顾性分析2017年10月至2022年2月新疆医科大学第一附属医院收治Ⅱ1型IBDI型患者34例临床资料,按治疗方式不同分为内镜组(13例)和外科手术组(21例)。比较两组患者住院天数、住院费用、手术前后实验室检查指标、术中出血量、手术时间、术后并发症及出院后随访情况。结果内镜组术后第1天总胆红素、直接胆红素水平均低于外科手术组,手术时间、术中出血量、住院天数及住院费用均少于外科手术组,差异有统计学意义(P<0.05)。两组修复时机比较差异无统计学意义(χ2=0.095,P>0.05)。患者随访时间33.2(6.4~67.7)个月,随访有效率97.1%。近期并发症中Clavien-Dindo≥Ⅲ级9例,均为外科手术组患者。随访效果Terblanche评级:内镜组中优9例,良3例,差1例;外科手术组中优16例,良3例,差2例。两组远期疗效比较,差异无统计学意义(χ2=0.051,P>0.05)。结论Ⅱ1型IBDI的治疗方法应根据损伤具体情况来决定。内镜治疗具有微创、手术时间短、术后恢复快等优势,但长期多次更换支架增加了治疗费用、住院次数和并发症可能。而在术中即时发现胆管的横断伤及伴有血管损伤时,外科手术治疗仍作为首选。

Objective To explore the clinical efficacy of different treatment methods for the same classification of iatrogenic bile duct injury(IBDI).Methods A retrospective analysis was carried out including the clinical data of 34 patients withⅡ1 type IBDI admitted to the First Affiliated Hospital of Xinjiang Medical University from October 2017 to February 2022.The patients were divided into the endoscopic group(13 cases)and the surgical group(21 cases)according to different treatment methods.The hospitalization days,hospitalization expenses,laboratory examination indicators before and after surgery,intraoperative bleeding,operation time,postoperative complications,and follow-up after discharge were compared between the two groups.Results The total bilirubin and direct bilirubin levels in the endoscopic group on the first day after surgery were lower than those in the surgical group,and the operation time,intraoperative bleeding,hospitalization days,and hospitalization expenses were lower than those in the surgical group,with statistically significant differences(all P<0.05).There was no statistically significant difference in repair timing between the two groups(χ2=0.095,P>0.05).The patients were followed up for 33.2(6.4-67.7)months,with a follow-up effective rate of 97.1%.Among the short-term complications,9 patients with Clavien-Dindo≥Ⅲwere in the surgical group.Follow-up effect Terblanche rating:in the endoscopic group,9 cases were excellent,3 cases were good,and 1 case was poor;in the surgical group,16 cases were excellent,3 cases were good,and 2 cases were poor.There was no statistically significant difference in long-term efficacy between the two groups(χ2=0.051,P>0.05).Conclusions The treatment of 1 type IBDI may be determined based on the specific situation of the injury.Endoscopic therapy has the advantages of minimally invasive surgery,short operation time,and rapid postoperative recovery.However,long-term and repeated stent replacement increases treatment costs,hospital stays,and complications.Surgical treatment is still the first choice when bile duct transection and vascular injury are immediately detected during IBDI surgery.