Present status of the treatment of iatrogenic bile duct injury
10.3760/cma.j.issn.1673-9752.2009.06.001
- VernacularTitle:医源性胆管损伤的治疗现状
- Author:
Hongchi JIANG
;
Xian JIANG
- Publication Type:Journal Article
- Keywords:
Bile duct injury;
iatrogenic;
Therapy
- From:
Chinese Journal of Digestive Surgery
2009;8(6):401-403
- CountryChina
- Language:Chinese
-
Abstract:
Iatrogenic bile duct injury (IBDI) is a severe complication in general surgery, especially during laparos-eopic 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 patholo-gical 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 extrahepatie bile duct injuries. The variation of opportunities leads to different thera-peutic strategies. When the injuries are diagnosed intraopera-tively, 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 extra-peritoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is steno-sis, sometimes followed by fistula. Sufficient preoperative prepa-ration is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient.
