Therapeutic strategies of iatrogenic portal vein injury after cholecystectomy.
Therapeutic strategies of iatrogenic portal vein injury after cholecystectomy.
复制标题
胆囊切除术后医源性门静脉损伤的治疗策略。
DOI：
10.1016/j.jss.2013.06.032
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Bo Wang
中科院分区：
文献类型：
--
作者：
Z. Wang;Liang Yu;Wan;Jian;Dai Li;Yi Lu;Bo Wang
胆囊切除术后血管损伤的发生率通常被低估。虽然门静脉损伤是罕见的，但它们是毁灭性的。本研究的目的是分析合适的治疗策略，门静脉损伤的情况下，胆道injure.Materials和methodsEleven腹腔镜或开腹胆囊切除术后门静脉损伤的患者被称为我院2004年至2010年。本文回顾了严重门静脉损伤患者的临床表现、诊断和处理。所有患者均出院，无明显临床症状。在回顾性分析中，这些患者被分为早期，中期和晚期stages.ResultsAll 11例患者有门静脉和/或肝右动脉损伤，但没有观察到胆道损伤。在这些患者中，根据损伤的阶段进行不同的管理策略。8例患者在损伤时由经验丰富的肝胆外科医生直接缝合。2例患者胆囊切除术后接受溶栓和抗凝治疗，未再次手术。1例患者在损伤后3个月接受了肝移植。经长期随访，这些患者均无临床症状。结论门静脉损伤的早期，直接修复或缝合是重要的。门静脉损伤急性大面积血栓的中期保守溶栓抗凝治疗可能具有重要意义。肝移植是一种挽救性治疗，应在晚期使用。
BackgroundThe incidence of vascular injury after a cholecystectomy is often underestimated. Although injuries to the portal vein are rare, they are devastating. The aim of the present study was to analyze suitable therapeutic strategies regarding portal vein injury in the absence of biliary injury.Materials and methodsEleven patients with portal vein injuries after laparoscopic or open cholecystectomy were referred to our hospital between 2004 and 2010. The clinical presentation, diagnosis, and management of patients with severe portal vein injuries were reviewed. All the patients were discharged without outstanding clinical conditions. During retrospective analysis, these patients were divided into early, middle, and late stages.ResultsAll the 11 patients had a portal vein and/or right hepatic artery injury, but no biliary injuries were observed. Among these patients, different management strategies were managed according to the stage of the injury. Eight patients received a direct suture at the time of injury by an experienced hepatobiliary surgeon. Two patients received thrombolytic and anticoagulation therapy after cholecystectomy, without additional surgery. One patient received a liver transplant 3 mo after the injury. After long-term follow-up, these patients had no clinical conditions.ConclusionsDirect repair or suture is important during the early stage of portal vein injury. Conservative thrombolytic and anticoagulation therapy may serve an important role in the treatment of acute massive thrombus in portal vein injury during the middle stage. Liver transplantation is a salvage therapy that should be used during the late stage.