Aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares

Objetivo: avaliar os aspectos epidemiologicos de pacientes com lesoes iatrogenicas das vias biliares no Servicode Cirurgia Geral e do Aparelho Digestivo do Hospital Universitario Joao de Barros Barreto nos ultimos 10 anos.Metodo: estudo transversal e retrospectivo dos prontuarios de 25 pacientes com diagnostico de lesao iatrogenica davia biliar. Foram incluidos pacientes oriundos do proprio servico e de outras instituicoes. O periodo foi de janeirode 1999 a dezembro de 2008. Resultados: foram encontrados 25 casos de lesoes iatrogenicas das vias biliares,sendo 22 consequentes de colecistectomias convencionais. Um total de 56% foi procedente de outras instituicoes. Asmanifestacoes clinicas mais prevalentes: dor abdominal (88%), ictericia (76%) e coluria (56%). O tempo de evolucaodos sintomas variou desde 1o pos-operatorio ate 168 meses (14 anos). Cerca de 16% apresentavam diagnostico decolangite no momento da internacao. O metodo de diagnostico mais utilizado foi a colangiopancreatografia retrogadaendoscopica (48%), seguida da colangiorressonância (28%). As estenoses classificadas como Bismuth II foramas mais encontradas (40%), seguidas de Bismuth III (32%). A cirurgia corretiva foi a hepatico-jejunoanastomoseem Y de Roux (92%). As lesoes vasculares foram as principais complicacoes intra-operatorias. O tempo mediode internacao foi de 21dias. Conclusao: a maioria dos casos de iatrogenias foi proveniente de colecistectomiasconvencionais, realizadas em centros nao especializados em cirurgia de vias biliares. O respeito ao rigor tecnico dacirurgia permanece sendo medida preventiva mais eficaz para a diminuicao da incidencia de iatrogenias das viasbiliares(AU) Objective: to evaluate the epidemiological aspects of iatrogenic injuries of bile ducts of patients seen in generalsurgery service and the digestive system of the University Hospital Joao de Barros Barreto in the last 10 years.Method: we performed an observational study, the type of retrospective medical records of patients with iatrogenicinjury of the biliary tract. We included patients from the service itself and other institutions. The variables studiedwere sex, age, origin, clinical manifestations, presence of cholangitis, time course, diagnostic method used, surgerythat caused the injury, surgery for the correction, the second Bismuth classification of the lesion, intraoperativecomplications surgery and hospital stay. Results: we found 25 cases of iatrogenic biliary tract, with 22 resulting fromconventional cholecystectomy. A total of 56% came other institutions. The female sex was more prevalent (80%), theaverage age of patients was 43 years. The most prevalent clinical manifestations: abdominal pain (88%), jaundice(76%) and dark urine (56%). The duration of symptoms ranged from 1 postoperative day up to 168 months (14years). About 16% had a diagnosis of cholangitis at admission. The method most frequently used is the endoscopicretrograde cholangiopancreatography (48%), followed by magnetic resonance cholangiography (28%). The stenosesclassified as Bismuth II were the most frequent (40%), followed by Bismuth III (32%). Corrective surgery washepatic-jejunoanastomose Roux-Y (92%). Vascular lesions were the major intraoperative complications. The meanhospital stay was 21 days. Conclusion: most cases of iatrogenic injuries came from conventional cholecystectomyperformed in centers not specialized in surgery of the biliary tract. Respect for the technical accuracy of the surgeryremains the most effective preventive measure for reducing the incidence of iatrogenic injuries of bile ducts.(AU)