PDF(Pubmed)
Abstract：
Impact of timing of repair on outcomes of patients repaired with Hepp-Couinaud hepatico-jejunostomy (HC-HJ) after bile duct injury (BDI) during cholecystectomy remains debated. This is an observational retrospective study at a tertiary referral hepato-biliary center. HC-HJ was always performed in patients without sepsis or bile leak and with dilated bile ducts. Timing of repair was classified as: early (≤ 2 weeks), intermediate (> 2 weeks, ≤ 6 weeks), and delayed (> 6 weeks). 114 patients underwent HC-HJ between 1994 and 2022: 42.1% underwent previous attempts of repair at referring institutions (Group A) and 57.9% were referred without any attempt of repair before referral (Group B). Overall, a delayed HC-HJ was performed in 78% of patients; intermediate and early repair were performed in 17% and 6%, respectively. In Group B, 10.6% of patients underwent an early, 27.3% an intermediate, and 62.1% a delayed repair. Postoperative mortality was nil. Median follow-up was 106.7 months. Overall primary patency (PP) attainment rate was 94.7%, with a 5- and 10-year actuarial primary patency (APP) of 84.6% and 84%, respectively. Post-repair bile leak was associated with PP loss in the entire population (odds ratio [OR] 9.75, 95% confidence interval [CI] 1.64-57.87, p = 0.012); no correlation of PP loss with timing of repair was noted. Treatment of anastomotic stricture (occurred in 15.3% of patients) was performed with percutaneous treatment, achieving absence of biliary symptoms in 93% and 91% of cases at 5 and 10 years, respectively. BDI can be successfully repaired by HC-HJ regardless of timing when surgery is performed in stable patients with dilated bile ducts and without bile leak.
摘要：
胆囊切除术中胆管损伤（BDI）后，修复时机对Hepp-Couinaud肝空肠吻合术（HC-HJ）修复患者预后的影响仍存在争议。这是三级转诊肝胆中心的一项观察性回顾性研究。HC-HJ总是在没有败血症或胆漏以及胆管扩张的患者中进行。修复时间分为：早期（≤2周），中级（>2周，≤6周)，并延迟（>6周）。在1994年至2022年期间，114例患者接受了HC-HJ治疗：42.1%曾在转诊机构尝试过修复（A组），57.9%在转诊前没有尝试修复（B组）。总的来说,78％的患者进行了延迟的HC-HJ；17％和6％的患者进行了中期和早期修复，分别。B组,10.6%的患者接受了早期，27.3%的中间体，和62.1%的延迟修复。术后死亡率为零。中位随访时间为106.7个月。总体原发通畅(PP)达标率为94.7%,5年和10年精算初级通畅率(APP)为84.6%和84%，分别。修复后胆漏与整个人群的PP损失有关（比值比[OR]9.75，95％置信区间[CI]1.64-57.87，p=0.012）；PP损失与修复时间无相关性。吻合口狭窄的治疗（发生在15.3％的患者中）采用经皮治疗，在5年和10年时，93%和91%的病例没有胆道症状，分别。无论在胆管扩张且没有胆漏的稳定患者中进行手术的时机如何，HC-HJ都可以成功修复BDI。
