Background

Bile duct injury (BDI) after cholecystectomy remains a significant surgical challenge. No guideline exists to guide the timing of repair, while few studies compare early versus late repair BDI. This study aimed to analyze the outcomes in patients undergoing immediate, intermediate, and delayed repair of BDI.

Methods

We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020. The patients were divided into three groups based on the time of BDI reconstruction. Group 1 underwent an immediate reconstruction (within the first 72 hours post-cholecystectomy, n = 156); group 2 underwent an intermediate reconstruction (from 4 days to 6 weeks post-cholecystectomy, n = 75), and group 3 underwent delayed reconstruction (after 6 weeks post-cholecystectomy, n = 181).

Results

Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3. Favorable outcome was observed in 111 (71.2%) patients in group 1, 31 (41.3%) patients in group 2, and 157 (86.7%) patients in group 3 (P = 0.0001). Multivariate analysis identified that complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1, the use of external stent was an independent factor of favorable outcome in group 2, and level E4 BDI was an independent factor of unfavorable outcome in group 3. Transected BDI and level E4 BDI were independent factors of unfavorable outcome.

Conclusions

Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI. Complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of a favorable outcome.

中文翻译：

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转诊模式和修复时机对胆囊切除术后胆管损伤重建术后手术结果的影响：一项多中心研究

背景

胆囊切除术后的胆管损伤 (BDI) 仍然是一项重大的手术挑战。不存在指导修复时间的指南，而很少有研究比较早期和晚期修复 BDI。本研究旨在分析接受 BDI 立即、中间和延迟修复的患者的结果。

方法

我们回顾性分析了 2015 年 3 月至 2020 年 1 月的 412 例 BDI 患者。根据 BDI 重建的时间将患者分为三组。第 1 组立即进行重建（在胆囊切除术后的前 72 小时内，n  = 156）；第 2 组进行了中间重建（从胆囊切除术后 4 天到 6 周，n  = 75），第 3 组进行了延迟重建（在胆囊切除术后 6 周后，n  = 181）。

结果

与第 1 组和第 3 组相比，第 2 组患者的早期并发症（包括吻合口漏和腹腔内收集）以及晚期并发症（包括吻合口狭窄和继发性肝硬化）显着更多。 第 1 组 31 名患者的 111 名 (71.2%) 观察到了良好的结果第 2 组 (41.3%) 患者和第 3 组 157 (86.7%) 名患者 ( P  = 0.0001)。多因素分析发现，胆管完全结扎、E1 BDI 水平和使用外支架是第 1 组良好结果的独立因素，使用外支架是第 2 组良好结果的独立因素，E4 BDI 水平是第 3 组不良结果的独立因素。横断面 BDI 和 E4 BDI 是不良结果的独立因素。

结论

在胆囊切除术后 BDI 的立即和延迟重建中更常观察到有利的结果。胆管完全结扎、E1 BDI 水平和外部支架的使用是有利结果的独立因素。