Risk factors and treatments of biliary tract injury caused by laparoscopic cholecystectomy

doi:10.3877/cma.j.issn.2095-3232.2021.05.008

Abstract

Abstract:

Objective

To investigate the risk factors, treatments and clinical prognosis of patients with biliary tract injury caused by laparoscopic cholecystectomy (LC).

Methods

Clinical data of 6 830 patients undergoing LC admitted to Affiliated Hospital of Jiangnan University from January 2008 to January 2020 were retrospectively analyzed. Among them, 3 063 patients were male and 3 767 female, aged (51±6) years on average. All patients were divided into the biliary tract injury group (n=17) and control group (n=6 813) according to whether biliary tract injury occurred. The informed consents of all patients were obtained and the local ethical committee approval was received. The potential risk factors, treatments and clinical prognosis of patients with biliary tract injury were analyzed. Preoperative neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) between two groups were statistically compared by t test. The rate comparison was performed by Chi-square test.

Results

The incidence of bile duct injury caused by LC was 2.49% (17/6 830). In the biliary tract injury group, preoperative NLR and CRP were 1.4±0.4 and (1.8±0.6) mg/L, which were significantly higher than 1.2±0.3 and (1.5±0.4) mg/L in the control group (t=2.742, 3.084; P<0.05). Thickening of gallbladder wall, anatomical variation of biliary tract, incarcerated gallstones at the neck of gallbladder were significantly associated with the biliary tract injury (χ²=4.418, 4.046, 4.361; P<0.05). Among 17 patients, the bile duct injury in 10 cases were found intraoperatively and were immediately repaired during operation, while 7 patients were diagnosed after operation, who were treated with ligation of vagal bile duct, biliary repair, end-to-end anastomosis of biliary tract, biliary-intestinal anastomosis and abdominal drainage. Most patients recovered well after operation, and only 1 case suffered from recurrent acute cholangitis.

Conclusions

Severe preoperative inflammatory reaction, thickening of gallbladder wall, anatomical variation of biliary tract and incarcerated gallstones at the neck of gallbladder are the risk factors for biliary tract injury caused by LC. In clinical practice, corresponding preventive measures should be delivered according to the risk factors, thereby reducing the incidence of LC-induced bile duct injury.

Key words: Cholecystectomy, laparoscopic, Biliary duct injury, Risk factors, Treatment

Shuo Zhang, Jun Yang, Yuanlong Gu. Risk factors and treatments of biliary tract injury caused by laparoscopic cholecystectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 470-473.

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References 20

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组别	例数	年龄（岁，±s）	性别（例）		ASA评分（例）		BMI（kg/m²，±s）	WBC（×10⁹/L，±s）	ALT（U/L，±s）	TB（μmol/L，±s）	GGT（U/L，±s）
组别	例数	年龄（岁，±s）	男	女	≤2分	>2分	BMI（kg/m²，±s）	WBC（×10⁹/L，±s）	ALT（U/L，±s）	TB（μmol/L，±s）	GGT（U/L，±s）
胆道损伤组	17	52±17	7	10	16	1	25±5	6.9±1.8	32±12	13±5	27±21
对照组	6 813	51±6	3 063	3 767	6 587	226	25±5	6.5±2.0	28±10	12±3	23±13
统计值		t=0.681	χ²=0.092		χ²=0.284		t=0.389	t=0.607	t=1.421	t=0.459	t=0.955
P值		0.248	0.761		0.594		0.349	0.547	0.162	0.649	0.344

组别	例数	年龄（岁，±s）	性别（例）		ASA评分（例）		BMI（kg/m²，±s）	WBC（×10⁹/L，±s）	ALT（U/L，±s）	TB（μmol/L，±s）	GGT（U/L，±s）
组别	例数	年龄（岁，±s）	男	女	≤2分	>2分	BMI（kg/m²，±s）	WBC（×10⁹/L，±s）	ALT（U/L，±s）	TB（μmol/L，±s）	GGT（U/L，±s）
胆道损伤组	17	52±17	7	10	16	1	25±5	6.9±1.8	32±12	13±5	27±21
对照组	6 813	51±6	3 063	3 767	6 587	226	25±5	6.5±2.0	28±10	12±3	23±13
统计值		t=0.681	χ²=0.092		χ²=0.284		t=0.389	t=0.607	t=1.421	t=0.459	t=0.955
P值		0.248	0.761		0.594		0.349	0.547	0.162	0.649	0.344

组别	例数	NLR	CRP（mg/L）	胆囊壁厚度（例）		胆道解剖变异（例）		胆囊颈部结石嵌顿（例）		术者经验（例）
组别	例数	NLR	CRP（mg/L）	<4 mm	≥4 mm	无	有	无	有	<10年	≥10年
胆道损伤组	17	1.4±0.4	1.8±0.6	11	6	13	4	14	3	7	10
对照组	6 813	1.2±0.3	1.5±0.4	5 832	981	6 527	286	6 527	286	2 501	4 312
统计值		t=2.742	t=3.084	χ²=4.418		χ²=4.046		χ²=4.361		χ²=0.146
P值		0.003	0.010	0.036		0.044		0.037		0.703

组别	例数	NLR	CRP（mg/L）	胆囊壁厚度（例）		胆道解剖变异（例）		胆囊颈部结石嵌顿（例）		术者经验（例）
组别	例数	NLR	CRP（mg/L）	<4 mm	≥4 mm	无	有	无	有	<10年	≥10年
胆道损伤组	17	1.4±0.4	1.8±0.6	11	6	13	4	14	3	7	10
对照组	6 813	1.2±0.3	1.5±0.4	5 832	981	6 527	286	6 527	286	2 501	4 312
统计值		t=2.742	t=3.084	χ²=4.418		χ²=4.046		χ²=4.361		χ²=0.146
P值		0.003	0.010	0.036		0.044		0.037		0.703

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