Abstract
From 1990 to 1995, 27 patients with biliary injuries were treated at the Department of General Surgery of Münster University Hospitals. All lesions occurred during cholecystectomy, either via laparoscopy (n = 17) or via laparotomy (n = 10). Ten patients were male and 17 female. The mean age was 51.2 years. In all cases a preoperative ERCP was performed. Based on the FRCP status a new classification was developed taking into account the type and location of the injury, as well as the opportunity for endoscopic treatment. Twenty-two patients underwent surgical bile duct reconstruction (12 hepaticojejunostomies, 3 eholedochojejunostomies, 7 direct reconstructions). In five cases endoscopic therapy alone was successful. The perioperative mortality was 7.4% (2/27). Three of the surviving 25 had to be readmitted for recurrent cholangitis. Only 15 feel well without any limitations on everyday activities.
Zusammenfassung
Von 1990–1995 wurden an der Klinik für Allgemeine Chirurgie der Westfälischen Wilhelms-Universität insgesamt 27 Patienten mit Gallenwegsverletzungen behandelt. Alle Verletzungen traten im Rahmen einer Cholezystektomie auf (laparoskopisch n = 17; per Laparotomie n = 10). 10 Patienten waren männlich und 17 weiblich. Das Durchschnittsalter lag bei 51,2 Jahren. In allen Fällen wurde eine präoperative ERCP durchgeführt. Basierend auf dem ERCP-Befund wurde eine neue Klassifikation entwickelt, welche Typ und Ort der Verletzung sowie die Möglichkeit der endoskopischen Therapie berücksichtigt. Bei 22 Patienten wurde chirurgisch eine Gallenwegsrekonstruktion durchgeführt (12 Hepatikojejunostomien, 3 Choledochojejunostomien, 7 direkte Gangrekonstruktionen). In 5 Fällen war die endoskopische Therapie allein erfolgreich. Die perioperative Letalität errechnete sich mit 7,4% (2 von 27). Drei der überlebenden 25 Patienten mußten erneut wegen rezidivierender Cholangitiden aufgenommen werden. Nur 15 Patienten fühlten sich wohl ohne Einschränkungen im Alltagsleben.
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Sulkowski, U., Brockmann, J. & Dinse, P. Verletzungen der extrahepatischen Gallenwege. Langenbecks Arch Chir 381, 246–250 (1996). https://doi.org/10.1007/BF00184044
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DOI: https://doi.org/10.1007/BF00184044