腹腔镜胆囊切除术相关胆管损伤的研究进展
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摘要
腹腔镜胆囊切除术(LC)经历30余年的发展,已逐步替代开腹胆囊切除术(OC)成为治疗症状性胆囊结石金标准术式。然而,LC相关并发症尤其胆管损伤(BDI),因其后果的严重性而引起广泛关注。笔者从BDI的病因、诊断、分类、治疗及预后等方面的最新研究进展进行综述,以深入阐述BDI的病情演变特征,并着重于手术方式发展情况以便服务于临床,为BDI的规范化诊疗提供参考。
After more than 30 years of development, laparoscopic cholecystectomy(LC) has gradually replaced open cholecystectomy(OC) and become the gold standard therapeutic option for the treatment of symptomatic cholecystolithiasis. However, the LC-associated complications, especially bile duct injury(BDI), have generated widespread concern due to the severity of their consequences. Here, the authors address the research progress of BDI in terms of etiology, diagnosis, classification, treatment and prognosis, in order to elaborate the evolutionary characteristics of BDI, with an emphasis on the development of surgical procedures for helping in clinical practice, and establishment of the standardized diagnosis and treatment of BDI.
After more than 30 years of development, laparoscopic cholecystectomy(LC) has gradually replaced open cholecystectomy(OC) and become the gold standard therapeutic option for the treatment of symptomatic cholecystolithiasis. However, the LC-associated complications, especially bile duct injury(BDI), have generated widespread concern due to the severity of their consequences. Here, the authors address the research progress of BDI in terms of etiology, diagnosis, classification, treatment and prognosis, in order to elaborate the evolutionary characteristics of BDI, with an emphasis on the development of surgical procedures for helping in clinical practice, and establishment of the standardized diagnosis and treatment of BDI.
引文
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[31]Tocchi A,Mazzoni G,Liotta G,et al.Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease:a follow-up study of more than 1,000 patients[J].Ann Surg,2001,234(2):210-214.
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[33]Gluszek S,Kot M,Balchanowski N,et al.Iatrogenic bile duct injuries--clinical problems[J].Pol Przegl Chir,2014,86(1):17-25.doi:10.2478/pjs-2014-0004.
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[38]de Santiba?es E,Ardiles V,Gadano A,et al.Liver transplantation:the last measure in the treatment of bile duct injuries[J].World JSurg,2008,32(8):1714-1721.doi:10.1007/s00268-008-9650-5.
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[2]Karvonen J,Salminen P,Gronroos JM.Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era:alarming trends[J].Surg Endosc,2011,25(9):2906-2910.doi:10.1007/s00464-011-1641-1.
[3]蔡秀军.腹腔镜在腹部外科应用的现状及发展方向[J].中华医学杂志,2005,85(3):145-148.doi:10.3760/j:issn:0376-2491.2005.03.001.Cai XJ.Laparoscopic surgery in the treatment of abdominal diseases:present status and prspects[J].National Medical Journal ofChina,2005,85(3):145-148.d o i:10.3760/j:issn:0376-2491.2005.03.001.
[4]Beckingham IJ.Gallstones[J].Surgery(Oxford),2017,35(12):682.doi:https://doi.org/10.1016/j.mpsur.2017.09.013.
[5]Sajid MS,Leaver C,Haider Z,et al.Routineon-table cholangiography during cholecystectomy:a systematic review[J].Ann R Coll Surg Engl,2012,94(6):375-380.doi:10.1308/003588412X13373405385331.
[6]Parmeggiani D,Cimmino G,Cerbone D,et al.Biliary tract injuries during laparoscopic cholecystectomy:three case reports and literature review[J].G Chir,2010,31(1/2):16-19.
[7]Koike D,Suka Y,Nagai M,et al.Laparoscopic Management of Mirizzi Syndrome Without Dissection of Calot's Triangle[J].JLaparoendosc Adv Surg Tech A,2017,27(2):141-145.doi:10.1089/lap.2016.0426.
[8]Jung HS,Huh K,Shin YH,et al.Left-sided gallbladder:a complicated percutaneous cholecystostomy and subsequent hepatic embolisation[J].Br J Radiol,2009,82(979):e141-144.doi:10.1259/bjr/59092209.
[9]陈智勇,陈文有,杨爱国.腹腔镜胆囊切除术并发症发生的相关影响因素分析[J].中国普通外科杂志,2016,25(2):214-218.doi:10.3978/j.issn.1005-6947.2016.02.010.Chen ZY,Chen WY,Yang AG.Analysis of influential factors for complications associated with laparoscopic cholecystectomy[J].Chinese Journal of General Surgery,2016,25(2):214-218.doi:10.3978/j.issn.1005-6947.2016.02.010.
[10]Francoeur JR,Wiseman K,Buczkowski AK,et al.Surgeons'anonymous response after bile duct injury during cholecystectomy[J].Am J Surg,2003,185(5):468-475.
[11]Bobkiewicz A,Krokowicz?,Banasiewicz T,et al.Iatrogenic bile duct injury.A significant surgical problem.Assessment of treatment outcomes in the department's own material[J].Pol Przegl Chir,2015,86(12):576-583.doi:10.1515/pjs-2015-0004.
[12]Sicklick JK,Camp MS,Lillemoe KD,et al.Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy:perioperative results in 200 patients[J].Ann Surg,2005,241(5):786-792.
[13]Archer SB,Brown DW,Smith CD,et al.Bile duct injury during laparoscopic cholecystectomy:results of a national survey[J].Ann Surg,2001,234(4):549-558.
[14]Hajjar NA,Tomu?C,Mocan L,et al.Management of bile duct injuries following laparoscopic cholecystectomy:long-term outcome and risk factors infuencing biliary reconstruction[J].Chirurgia(Bucur),2014,109(4):493-499.
[15]Yi F,Jin WS,Xiang DB,et al.Complications of laparoscopic cholecystectomy and its prevention:a review and experience of400 cases[J].Hepatogastroenterology,2012,59(113):47-50.doi:10.5754/hge11232.
[16]Aduna M,Larena JA,Martín D,et al.Bile duct leaks after laparoscopic cholecystectomy:value of contrast-enhanced MRCP[J].Abdom Imaging,2005,30(4):480-487.doi:10.1007/s00261-004-0276-2.
[17]刘平西,周钧,唐腾龙,等.腹腔镜胆囊切除术联合ERCP解决术中棘手问题30例分析[J].中国普通外科杂志,2015,24(2):293-296.doi:10.3978/j.issn.1005-6947.2015.02.028.Liu PX,Zhou J,Tang TL,et al.The solution of difficult problems encountered during laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography:an analysis of 30cases[J].Chinese Journal of General Surgery,2015,24(2):293-296.doi:10.3978/j.issn.1005-6947.2015.02.028.
[18]陈章彬,陈见中,滕毅山.经皮经肝穿刺胆道引流术在腹腔镜下胆道探查术后一期缝合中的应用价值[J].中国普通外科杂志,2018,27(2):156-162.doi:10.3978/j.issn.1005-6947.2018.02.004.Chen ZB,Chen JZ,Teng YS.Application value of percutaneous transhepatic cholangial drainage in laparoscopic common bile duct exploration with primary closure[J].Chinese Journal of General Surgery,2018,27(2):156-162.d o i:10.3978/j.issn.1005-6947.2018.02.004.
[19]Wojcicki M,Patkowski W,Chmurowicz T,et al.Isolated right posterior bile duct injury following cholecystectomy:report of two cases[J].World J Gastroenterol,2013,19(36):6118-6121.doi:10.3748/wjg.v19.i36.6118.
[20]Strasberg SM,Hertl M,Soper NJ.An analysis of the problem of biliary injury during laparoscopic cholecystectomy[J].J Am Coll Surg,1995,180(1):101-125.
[21]Rauws EA,Gouma DJ.Endoscopic and surgical management of bile duct injury after laparoscopic cholecystectomy[J].Best Pract Res Clin Gastroenterol,2004,18(5):829-846.doi:10.1016/j.bpg.2004.05.003.
[22]中华医学会外科学分会胆道外科学组.胆管损伤的诊断和治疗指南(2013版)[J].中华消化外科杂志,2013,12(2):81-95.doi:10.3760/cma.j.issn.1673-9752.2013.02.001.Biliary Surgery Group of Surgery Branch of Chinese Medical.Association.Practice guideline for diagnosis and treatment of bile duct injury(2013 edition)[J].Chinese Journal of Digestive Surgery,2013,12(2):81-95.doi:10.3760/cma.j.issn.1673-9752.2013.02.001.
[23]Massarweh NN,Devlin A,Symons RG,et al.Risk tolerance and bile duct injury:surgeon characteristics,risk-taking preference,and common bile duct injuries[J].J Am Coll Surg,2009,209(1):17-24.doi:10.1016/j.jamcollsurg.2009.02.063.
[24]Chinnery GE,Krige JE,Bornman PC,et al.Endoscopic management of bile leaks after laparoscopic cholecystectomy[J].SAfr J Surg,2013,51(4):116-121.doi:10.7196/sajs.1829.
[25]Buddingh KT,Weersma RK,Savenije RA,et al.Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography[J].J Am Coll Surg,2011,213(2):267-274.doi:10.1016/j.jamcollsurg.2011.03.004.
[26]Beliaev AM,Booth M.Late two-stage laparoscopic cholecystectomy is associated with an increased risk of major bile duct injury[J].ANZ J Surg,2016,86(1/2):63-68.doi:10.1111/ans.12967.
[27]Jab?ońska B,Lampe P,Olakowski M,et al.Hepaticojejunostomy vs.end-to-end biliary reconstructions in the treatment of iatrogenic bile duct injuries[J].J Gastrointest Surg,2009,13(6):1084-1093.doi:10.1007/s11605-009-0841-7.
[28]Jablonska B.End-to-end ductal anastomosis in biliary reconstruction:indications and limitations[J].Can J Surg,2014,57(4):271-277.
[29]兰军良,董晓勇,畅文玲,等.腹腔镜胆囊切除术胆管损伤的诊治分析[J].中国普通外科杂志,2017,26(8):1076-1080.doi:10.3978/j.issn.1005-6947.2017.08.018.Lan JL,Dong XY,Chang WL,et al.Analysis of diagnosis and treatment of laparoscopic cholecystectomy-related bile duct injury[J].Chinese Journal of General Surgery,2017,26(8):1076-1080.doi:10.3978/j.issn.1005-6947.2017.08.018.
[30]Thethy S,Thomson B,Pleass H,et al.Management of biliary tract complications after orthotopic liver transplantation[J].Clin Transplant,2004,18(6):647-653.doi:10.1111/j.1399-0012.2004.00254.x.
[31]Tocchi A,Mazzoni G,Liotta G,et al.Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease:a follow-up study of more than 1,000 patients[J].Ann Surg,2001,234(2):210-214.
[32]Liu H,Shen S,Wang YQ,et al.Biliary reconstruction and Rouxen-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury[J].Int Surg J,2015,2(2):179-186.
[33]Gluszek S,Kot M,Balchanowski N,et al.Iatrogenic bile duct injuries--clinical problems[J].Pol Przegl Chir,2014,86(1):17-25.doi:10.2478/pjs-2014-0004.
[34]Li J,Frilling A,Nadalin S,et al.Timing and risk factors of hepatectomy in the management of complications following laparoscopic cholecystectomy[J].J Gastrointest Surg,2012,16(4):815-820.doi:10.1007/s11605-011-1769-2.
[35]Jablonska B.Hepatectomy for bile duct injuries:when is it necessary?[J].World J Gastroenterol,2013,19(38):6348-6352.doi:10.3748/wjg.v19.i38.6348.
[36]Lubikowski J,Chmurowicz T,Post M,et al.Liver transplantation as an ultimate step in the management of iatrogenic bile duct injury complicated by secondary biliary cirrhosis[J].Ann Transplant,2012,17(2):38-44.
[37]Parrilla P,Robles R,Varo E,et al.Liver transplantation for bile duct injury after open and laparoscopic cholecystectomy[J].Br J Surg,2014,101(2):63-68.doi:10.1002/bjs.9349.
[38]de Santiba?es E,Ardiles V,Gadano A,et al.Liver transplantation:the last measure in the treatment of bile duct injuries[J].World JSurg,2008,32(8):1714-1721.doi:10.1007/s00268-008-9650-5.
[39]Sahajpal AK,Chow SC,Dixon E,et al.Bile duct injuries associated with laparoscopic cholecystectomy:timing of repair and longterm outcomes[J].Arch Surg,2010,145(8):757-763.doi:10.1001/archsurg.2010.153.
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