拉合尔谢赫-扎耶德医院肝胆科接诊的胆管损伤病例及处理方法。

Abubakar Siddiqui, Tariq Ali Bangash, Amer Latif, Asif Naveed, Hussam Ahmed, Muhammad Zeb, Muhammad Abbas
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摘要

目的了解肝胆科接诊的胆管损伤 (BDI) 的模式和处理方法。研究设计:描述性横断面。研究地点拉合尔谢赫-扎耶德医院肝胆科。时间: 2022 年 11 月 1 日至 2022 年 4 月2022 年 11 月 1 日至 2023 年 4 月 30 日。研究方法共纳入 79 名胆管损伤患者。提供人口统计学数据并进行相关检查。采用 Strausberg 分类法对胆管损伤的严重程度进行分类。患者接受适当的手术治疗,术后并发症随访 6 个月。结果平均年龄为(39.89±10.01)岁,主要为女性(81%)。腹腔镜胆囊切除术导致 BDI 的占 44.3%,开腹胆囊切除术导致 BDI 的占 51.9%,转为开腹手术的占 3.8%。黄疸(58.2%)、胆漏(38.0%)和瘙痒(3.8%)是常见症状。手术方法包括肝空肠吻合术(77.2%)、右肝切除加肝空肠吻合术(8.9%)和肝切除+肝空肠吻合术(13.9%)。BDI 分级显示有 E2(57.0%)、E3(36.7%)和 E4(6.3%)病例。11.4%的病例出现手术部位感染。术后5.1%的患者出现吻合口漏,只有BDI部位是导致吻合口漏的重要因素,P值小于0.001。结论总之,大多数 BDI 为 E2(57.0%)、E3(36.7%)和 E4(6.3%)。手术方式为肝空肠吻合术(77.2%)、右肝切除加肝空肠吻合术(8.9%)和肝切除+肝空肠吻合术(13.9%)。吻合口漏与 BDI 的部位密切相关。
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Pattern and management of bile duct injuries presented to Hepatobiliary Unit of Shaikh Zayed Hospital Lahore.
Objective: To find out the pattern and management of Bile Duct Injuries (BDIs) presented to Hepatobilliary unit. Study Design: Descriptive Cross Sectional. Setting: Hepatobiliary Unit, Shaikh Zayed Hospital Lahore. Period: November 1, 2022, to April 30, 2023. Methods: Total of 79 patients with Bile duct injuries were included. Demographic data and relevant investigations were performed. BDIs severity was classified using the Strausberg Classification. Patients underwent appropriate surgical interventions, with follow-up for period of 6 months postoperative complications. Results: The mean age was 39.89±10.01 yrs, primarily females (81%). BDI resulted from laparoscopic cholecystectomy in 44.3%, open cholecystectomy in 51.9%, and conversion to open surgery in 3.8% cases. Jaundice (58.2%), bile leak (38.0%), and itching (3.8%) were common presentations. Surgical procedures included hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). BDI classification revealed E2 (57.0%), E3 (36.7%), and E4 (6.3%) cases. Surgical site infection was observed in 11.4% of cases. Postoperatively 5.1% patients experienced anastomotic leaks and only the site of BDI was a significant factor for leak with the p value of <0.001. Conclusion: In conclusion the majority of BDIs were E2 (57.0%), E3 (36.7%), and E4 (6.3%).Procedure performed were hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). Anastomotic leaks were significantly linked to the site of BDI.
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