背景:目的是评估美国东南部三级肝胰胆道中心胆囊切除术中胆管损伤治疗的地理和人口统计学因素。
方法:所有胆囊切除术中胆道损伤的转诊,包括2017年1月至2020年12月。
结果:确定了19例患者,中位年龄为59岁(47-65岁),平均BMI为30.3(18-49),和糖尿病的患病率,高血压和心血管疾病的11%,47%和16%,分别。平均转移距离为76英里(8-102),中位转移时间为3天(1-12)。16人(84%)有StrasbergE受伤,4(21%)伴有血管损伤(3-右肝动脉,1-右门静脉)。两名(10.5%)进行了非手术管理,2例(10.5%)和15例(78.9%)患者接受了延迟修复,从损伤到修复的中位时间为87天(69~118天).中位手术时间为5小时(4-7小时),失血量为150mL(100-200),住院时间为8天(6-12).
结论:因素包括医院之间的距离,由于床位和运输,患者转移的延误,在延迟修复的决策中发挥作用。延迟修复有利于我们高危患者人群的医疗优化。
BACKGROUND: Aim is to evaluate geographical and demographic factors influencing management of bile duct injuries occurring during cholecystectomy in a tertiary hepato-pancreato-biliary center in Southeast US.
METHODS: All referrals for biliary injuries during cholecystectomy, between Jan 2017 and December 2020 were included.
RESULTS: 19 patients were identified with a median age of 59 (47-65), average BMI of 30.3 (18-49), and the prevalence of diabetes mellitus, hypertension and cardiovascular disease of 11%, 47% and 16%, respectively. The average transfer distance was 76 miles (8-102) and median transfer time was 3 days (1-12). 16 (84%) had Strasberg E injury, with 4 (21%) having a concomitant vascular injury (3 - right hepatic artery, 1 - right portal vein). Two (10.5%) were managed non-operatively, immediate surgical repair was performed in 2 (10.5%) and 15 (78.9%) patients underwent a delayed repair with a median of 87 days (69-118) from injury to repair. Median operative time was 5 hours (4-7), blood loss was 150 mL (100-200) and hospital stay was 8 days (6-12).
CONCLUSIONS: Factors including distance between hospitals, delays in patient transfer due to bed availability and transportation, play a role in the decision-making towards delayed repair. The delayed repair has the benefit of medical optimization of our high-risk patients\' population.