Медицинская литература. Новинки

 

 

 

 

 

 

Сочетанное повреждение желчных протоков и сосудов при холецистэктомии

Вы можете загрузить полный текст статьи в формате pdf

Цель. Оценка ближайших и отдаленных результатов хирургического лечения больных после сочетанных повреждений сосудов и желчных протоков. Материал и методы. С 2012 по 2021 г. наблюдали 157 пациентов с рубцовыми стриктурами желчных протоков. Согласно классификации повреждений желчных протоков Strasberg–Bismuth тип повреждения E1–2 выявлен у 22 пациентов, тип Е3 – у 77, тип Е4 – у 56. Из 141 пациента, перенесшего холецистэктомию, сочетанное повреждение сосудов и желчных протоков было выявлено у 5 (4%). Результаты. В 2 наблюдениях выполнена гемигепатэктомия с реконструкцией желчных протоков, трем пациентам осуществлена только реконструкция желчных протоков. Один пациент умер в раннем послеоперационном периоде, 3 пациентов продолжают лечение. В 1 наблюдении лечение успешно завершено. Заключение. Сочетанное повреждение желчных протоков и сосудов является редким тяжелым осложнением холецистэктомии. Успех лечения зависит от уровня и характера повреждения желчных протоков и сосудов, правильно выбранной тактики лечения.

Ключевые слова:
желчный пузырь, желчные протоки, сосуды печени, холецистэктомия, повреждение сосудов, повреждение желчных протоков, стриктура

Литература:
1. Гальперин Э.И., Чевокин А.Ю. Факторы, определяющие выбор операции при “свежих” повреждениях магистральных желчных протоков. Анналы хирургической гепатологии. 2009; 14 (1): 49-56.
2. Strasberg S.M., Picus D.D., Drebin J.A. Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component. J. Gastrointest. Surg. 2001; 5 (3): 266- 274. https://doi.org/10.1016/s1091-255x(01)80047-0
3. Майстренко Н.А., Ромашенко П.Н., Алиев А.К., Емельянов А.А., Феклюнин А.А. Хирургическое лечение ятрогенного повреждения желчевыводящего протока. Вестник хирургии им. И.И. Грекова. 2016; 175 (3): 83-85.
4. Nuzzo G., Giuliante F., Giovannini I., Ardito F., D'Acapito F., Vellone M., Murazio M., Capelli G. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch. Surg. 2005; 140 (10): 986-992. https://doi.org/10.1001/archsurg.140.10.986
5. Alves A., Farges O., Nicolet J., Watrin T., Sauvanet A., Belghiti J. Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann. Surg. 2003; 238 (1): 93-96. https://doi.org/10.1097/01.sla.0000074983.39297.c5
6. Sikora S.S. Management of post-cholecystectomy benign bile duct strictures: review. Indian J. Surg. 2012; 74 (1): 22-28. https://doi.org/10.1007/s12262-011-0375-6
7. Fingerhut A., Dziri C., Garden O.J., Gouma D., Millat B., Neugebauer E., Paganini A., Targarona E. ATOM, the allinclusive, nominal EAES classification of bile duct injuries during cholecystectomy. Surg. Endosc. 2013; 27 (12): 4608-4619. https://doi.org/10.1007/s00464-013-3081-6
8. Salman B., Akyurek N., Onal B., Cindoruk M. Combined proper hepatic artery and common hepatic duct injury in open cholecystectomy: case report and review of the literature. Adv. Ther. 2007; 24 (3): 639-647. https://doi.org/10.1007/BF02848789
9. Koffron A., Ferrario M., Parsons W., Nemcek A., Saker M., Abecassis M. Failed primary management of iatrogenic biliary injury: incidence and significance of concomitant hepatic arterial disruption. Surgery. 2001; 130 (4): 722-728; discussion 728-731. https://doi.org/10.1067/msy.2001.116682
10. Buell J.F., Cronin D.C., Funaki B., Koffron A., Yoshida A., Lo A., Leef J., Millis J.M. Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch. Surg. 2002; 137 (6): 703-708; discussion 708-710. https://doi.org/10.1001/archsurg.137.6.703
11. Stewart L., Robinson T.N., Lee C.M., Liu K., Whang K., Way L.W. Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J. Gastrointest. Surg. 2004; 8 (5): 523-530; discussion 530-531. https://doi.org/10.1016/j.gassur.2004.02.010
12. Le Roy B., Dupre A., Gallon A., Chabrot P., Gagniere J., Buc E. Liver hypertrophy: underlying mechanisms and promoting procedures before major hepatectomy. J. Visc. Surg. 2018; https://doi.org/https://doi.org/10.1016/j.jviscsurg.2018.03.005
13. Kim K.M., Park J.W., Lee J.K., Lee K.H., Lee K.T., Shim S.G. A comparison of preoperative biliary drainage methods for perihilar cholangiocarcinoma: endoscopic vs percutaneous transhepatic biliary drainage. Gut Liver. 2015; 9 (6): 791-799. https://doi.org/10.5009/gnl14243
14. Dilek O.N., Atay A. Dealing with hepatic artery traumas: a clinical literature review. World J. Clin. Cases. 2021; 9 (28): 8425-8440. https://doi.org/10.12998/wjcc.v9.i28.8425
15. Thomson B.N., Parks R.W., Madhavan K.K., Garden O.J. Liver resection and transplantation in the management of iatrogenic biliary injury. World J. Surg. 2007; 31 (12): 2363-2369. https://doi.org/10.1007/s00268-007-9234-9
16. Strasberg S.M., Helton W.S. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford). 2011; 13 (1): 1-14. https://doi.org/10.1111/j.1477-2574.2010.00225.x
17. Angelis N., Catena F., Memeo R. et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J. Emerg. Surg. 2021; 16 (1): 30. https://doi.org/10.1186/s13017-021-00369-w
18. Li J., Frilling A., Nadalin S., Paul A., Malago M., Broelsch C.E. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. Br. J. Surg. 2008; 95 (4): 460-465. https://doi.org/10.1002/bjs.6022
19. Трифонов С.А., Коваленко Ю.А., Варава А.Б., Вишневский В.А. Место и значение реконструктивных вмешательств у больных высокими рубцовыми стриктурами желчных протоков. Хирург. 2020; (3-4): 3-14. https://doi.org/10.33920/med-15-2002-01
20. Soares A.F., Castro e Silva Junior O., Ceneviva R., Roselino J.E., Zucoloto S. Biochemical and morphological changes in the liver after hepatic artery ligation in the presence or absence of extrahepatic cholestasis. Int. J. Exp. Pathol. 1993; 74 (4): 367-370.
21. Kleive D., Sahakyan M.A., Khan A., Fosby B., Line P.D., Labori K.J. Incidence and management of arterialin juries during pancreatectomy. Langenbecks Arch. Surg. 2018; 403 (3): 341-348. https://doi.org/10.1007/s00423-018-1666-1

Concomitant vascular and bile duct injury in cholecystectomy

Aim. To evaluate the immediate and long-term outcomes in surgical treatment of concomitant vascular and bile duct injuries. Materials and methods. 157 patients with cicatricial strictures of the bile ducts were observed from 2012 to 2021. According to the Strasberg-Bismuth classification of bile ducts injuries, type E1-2 was detected in 22 patients, type E3 – in 77, and E4 – in 56 patients. 141 patients underwent cholecystectomy and five of them (4%) were detected with concomitant vascular and bile duct injury. Results. Hemihepatectomy with bile duct reconstruction was performed in two cases; three patients underwent bile duct reconstruction only. One patient died in the early postoperative period, three patients continue treatment. In one case, treatment was successfully completed. Conclusion. Concomitant vascular and bile duct injury is a rare and severe complication of cholecystectomy. Success of treatment depends on the level and character of the vessels and bile duct damage, and treatment strategy.

Keywords:
gallbladder, bile ducts, hepatic vessels, cholecystectomy, vascular injury, bile duct injury, stricture