胆管损伤手术修复要点

Main points of surgical management for bile duct injury

外科手术仍然是胆管损伤以及损伤性胆管狭窄的主要治疗手段,其核心内容涉及近远端胆管的显露、吻合胆管的组织制备以及组织吻合等一系列手术步骤。在实施任何确定性手术前,外科医师都应仔细评估与损伤有关的细节并确定胆管损伤的分型,以此为依据选择合理的手术时机和手术方式。术中采取精细的外科操作,并遵循"吻合和重建应建立在无炎症、无缺血、无瘢痕的健康胆管上"的基本原则。成功的修复依赖于丰富的胆道外科经验和精准的胆道外科技术。

Surgery remains the mainstay of treatment for bile duct injury and traumatic bile duct stricture. The definitive repair involves a series of procedures including exposing the proximal bile duct above impaired site, trimming bile duct wall and biliary reshaping, various anastomosis and so on. Surgeon should identify all the information related injury prior to making any definitive repair. The rational treatment strategy including the timing of repair and surgical methods should be formulated according to the injury type. Surgical procedure must follow the fundamental principle of ＂Anastomosis and reconstruction must build upon healthy, non-ischemie, non-inflammation and non-scarred bile duct＂. Successful management is a surgical challenge requiring great specialized experience and precise surgical skill.