医源性胆管损伤的治疗现状

Present status of the treatment of iatrogenic bile duct injury

胆道的功能正常与否，直接关系到人体各方面机能的发挥。随着医学的发展，今天的外科已经没有手术禁区，但医源性胆管损伤仍是所有外科医生颇受困扰的难题。胆管损伤的复杂性（损伤性质、部位、程度、发现早晚、患者全身状况等）决定了处理方式的多样性。

Iatrogenic bile duct injury （IBDI） is a severe complication in general surgery, especially during laparoscopic cholecystectomy. Many factors may cause IBDI, in which the conscientiousness, skill and experience of the surgeons play a more important role than the abnormal anatomy and pathological changes of the patient. The Bismuth＇s classification, which originated from the era of open surgery, does not cover the whole spectrum of bile duct injuries. Strasberg＇s classification made a supplement by including other types of extrahepatic bile duct injuries. The variation of opportunities leads to different therapeutic strategies. When the injuries are diagnosed intraoperatively, a conversion to open surgery is the option of choice, and the prosthesis should be performed by a more experienced surgeon. If the bile duct injury is diagnosed in the early stage after operation, therapeutic principles are as follows： biliary peritonitis often required an emergency reoperation, while extraperitoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is stenosis, sometimes followed by fistula. Sufficient preoperative preparation is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient.