医源性胆管损伤的诊疗现状

The Diagnosis and Treatment Status of Iatrogenic Biliary Injury

摘要: 医源性胆管损伤(Iatrogenic Bile Duct Injury, IBDI)大多是由腹部手术、肝脏介入手术、肝脏或者胆管穿刺治疗等造成的，最常见于胆囊切除术。随着腹腔镜胆囊切除术的广泛开展，其发病率远高于开腹胆囊切除术。目前关于胆管损伤的分型尚未达成一致意见。医源性胆管损伤的诊断方法包括术中诊断、术后诊断、影像学方法等。医源性胆管损伤的治疗方案包括内镜或介入下治疗、外科手术(胆管修补术、胆管对端吻合术、组织替代修复术、胆管结扎术、胆管/肝管空肠吻合术、肝切除术、肝移植术等)。修复术后远期并发症包括如胆管/胆肠吻合口狭窄、肝叶萎缩、反复发作的胆管炎、继发性胆汁性肝硬化、门静脉高压症等)，这些远期并发症严重影响患者的生活质量。本文就医源性胆管损伤的原因、分型、诊断和治疗等角度探讨了医源性胆管损伤的相关研究现状。

Abstract: Iatrogenic bile duct injury (IBDI) is mainly caused by abdominal surgery, liver intervention surgery, and liver or bile duct puncture treatment, most commonly in cholecystectomy. With the widespread use of laparoscopic cholecystectomy, the incidence of IBDI is much higher than that of open chole-cystectomy. Currently, there is no consensus on the classification of bile duct injuries. The diagnostic methods for IBDI include intraoperative diagnosis, postoperative diagnosis, and imaging methods. The treatment options for IBDI include endoscopic or interventional therapy, surgical repair (bili-ary repair, end-to-end anastomosis, tissue replacement repair, biliary ligation, bili-ary/hepatic-intestinal anastomosis, liver resection, liver transplantation, etc.). Long-term complica-tions after repair surgery include biliary/intestinal anastomotic stricture, hepatic lobe atrophy, re-current cholangitis, secondary biliary cirrhosis, portal hypertension, etc., which seriously affect the quality of life of patients. In this paper, the research status of iatrogenic bile duct injury is discussed from the perspectives of the cause, classification, diagnosis and treatment of iatrogenic bile duct in-jury.