医源性胆管损伤行肝切除术的指征探讨

The Indication of Hepatectomy for Iatrogenic Bile Duct Injury

医源性胆管损伤(IBDI)是腹腔镜胆囊切除术中最常见的并发症。复杂的医源性胆管损伤涉及肝汇流的中断和肝脏血管的损伤,对复杂的医源性胆管损伤患者施行的肝部分切除的目的是去除血管或感染性病变引起的肝实质纤维化和肝萎缩,可以彻底消除胆道狭窄、胆汁淤积及反复发作的胆管炎。肝切除术在医源性胆管损伤的手术治疗中并不是一个标准及必需的程序,但却应被视为对胆囊切除术后胆管损伤外科治疗中的一部分。

Iatrogenic bile duct injuries（IBDI） is the most series complications of Laparoscopic Cholecystectomy（LC）. Complex IBDI involve disruption of hepatic confluence and injuries associated with vascular damage. The purpose of partial liver resection in patients with complex IBDI was to get rid of flbrotic and atrophic liver parenchyma with a high risk of secondary complications result from vascular or septic lesions. And the partial liver resection can get rid of biliary stricture,bile stasis and repeated cholangitis completely.Although hepatectomy is not a standard procedure for patients with IBDI, it should be considered as a part of the surgical remedy for the repair of a selected group of patients in cholecystectomy injuries.