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2012, Número 4

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Revista Cubana de Cirugía 2012; 51 (4)


Reconstrucción de 183 lesiones iatrogénicas de la vía biliar

González GJL, Menéndez NJ, González VJA, Pérez PJ, Quevedo GL

Idioma: Español
Referencias bibliográficas: 74
Paginas: 288-306
Archivo PDF: 112.57 Kb.


RESUMEN

Introducción: las lesiones iatrogénicas de la vía biliar constituyen una de las mayores preocupaciones para los cirujanos generales. Con el inicio de la llamada era laparoscópica se notó un aumento de la incidencia de estas lesiones, como era de esperar, al tratarse de la introducción de una nueva técnica; pero este aumento que llegó a ser el doble del que ocurría con la cirugía abierta ha permanecido así más allá de lo que pudiera esperarse de una curva de aprendizaje. El objetivo de este trabajo fue evaluar el comportamiento y resultado del tratamiento quirúrgico aplicado.
Métodos: se realizó un estudio descriptivo, de corte transversal en 183 pacientes con diagnóstico de lesión iatrogénica de la vía biliar principal, atendidos en el Hospital Clinicoquirúrgico “Hermanos Ameijeiras”, en el período comprendido entre mayo de 1983 y diciembre de 2008.
Resultados: la incidencia de las lesiones de la vía biliar en nuestro centro fue de 0,14 %. En toda la serie hubo un predominio del sexo femenino, con una edad media de 44,7 años. El tratamiento quirúrgico por vía convencional provocó más lesiones con 55,2 %, y se comprobó que la mayoría fueron diagnosticadas en el posoperatorio con predominio, de forma general, de las lesiones a menos de 2 cm del confluente hepático. La modalidad quirúrgica más empleada fue la hepaticoyeyunostomía en Y de Roux. Prevalecieron, como complicaciones posoperatorias, la fístula biliar externa y la infección de la herida quirúrgica.
Conclusiones: la correlación entre variables y los resultados del tratamiento mostraron que, tanto el empleo de drenaje externo, como la lesión tipo 5, constituyeron predictores de morbimortalidad posoperatoria.


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