Advances in Clinical Diagnosis and Treatment of Iatrogenic Bile Duct Injury_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 KOUGui-xiang ¹ ,  ChAIChen ²

1. Clinical Teaching and Research Section, Health Vocational College of Gansu Province, Lanzhou 730000, Gansu Province, China;
2. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu Province, China;

Corresponding author：

ChAIChen, Email: chasechai@126.com

Keywords：

Iatrogenic bile duct injury; Diagnosis; Treatment; Prevetion; Review literature

DOI：

10.7507/1007-9424.20140317

Video：

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Objective To explore the cause, clinical diagnosis and treatment, and prevention strategies of iatrogenic bile duct injury (IBDI). Methods By means of literature retrieval, the clinical diagnosis and treatment measures of patients with IBDI were summarized. Results The related risk factors of IBDI include man-made factors, the local anatomy variation factors, and pathological factors. According to the damage diagnosis time and local pathological state, the repair operations such as bile duct suture repair, biliary tract end to end anastomosis, bile duct jejunum Roux-en-Y anastomosis, bile duct jejunum Roux-en-Y anastomosis, and jejunal artificial valve forming, or liver resection, and liver transplantation were performed. Moreover, it was also available that biliary stent or papillary balloon dilation through ERCP for the bile duct distal stricture. Conclusions It is important that prevention of IBDI. Operation should pay attention to upper abdominal operation prior to the implementation of the correct understanding of IBDI. In case of IBDI, the reasonable repair operation mode should be choose according to the damage types and time, and it can significantly improve the treatment effect and quality of life of patients.

Citation： KOUGui-xiang, ChAIChen. Advances in Clinical Diagnosis and Treatment of Iatrogenic Bile Duct Injury. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1321-1324. doi: 10.7507/1007-9424.20140317 Copy

1.	Tantia O, Jain M, Khanna S, et al. Iatrogenic biliary injury:13305 cholecystectomies experienced by a single surgical team over more than 13 years[J]. Surg Endosc, 2008, 22(4):1077-1086.
2.	Törnqvist B, Strömberg C, Presson G, et al. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival aftercholecystectomy:population based cohort study[J]. BMJ, 2012, 345):e6457.
3.	秦乐运.冲吸钝性解剖法防止腹腔镜胆囊切除术中胆道损伤的应用心得[J].中国中西医结合外科杂志, 2013, 19(2):203-204.
4.	中华医学会外科学分会胆道外科学组.胆管损伤的诊断与治疗指南(2013版)[J].中华消化外科杂志, 2013, 12(2):81-95.
5.	郭盖章.腹腔镜胆囊切除术并发症28例教训分析[J].肝胆外科杂志, 2009, 17(6):451-452.
6.	黄志强.医源性胆管狭窄:胆道外科之痛[J].中华消化外科杂志, 2008, 7(1):1-5.
7.	陆秀泽.医源性胆管损伤中机械性损伤与热力损伤的临床治疗观察[J].中国医疗前沿, 2013, 8(10):37, 42.
8.	李良, 鲁俊, 张军, 等.腹腔镜胆总管切开取石在老年胆道结石患者中的应用[J].中华全科医学, 2011, 9(7):1037-1039.
9.	方金满, 潘文, 许先军, 等.胆囊切除相关性胆道损伤的诊治分析[J].肝胆外科杂志, 2013, 21(1):48-50.
10.	刘金钢.腹腔镜胆囊切除术中医源性胆管损伤的预防[J].中国实用外科杂志, 2011, 31(7):571-573.
11.	刘刚峰.胆囊切除术中胆道损伤的预防[J].中国临床研究, 2013, 26(6):581-582.
12.	刘群, 郭琪, 梁晓燕, 等.胆囊管正常变异的X线分析及临床意义[J].实用放射学杂志, 2002, 18(1):20-22.
13.	汪丽伟. 31例医源性胆管损伤诊疗体会[J].中国伤残医学, 2013, 21(4):111-112.
14.	袁德汗, 陈应军, 卫洪波, 等.腹腔镜胆囊切除术所致胆道损伤的相关危险因素分析[J].中国内镜杂志, 2013, 19(5):492-495.
15.	林擎天.医源性胆管损伤的诊治[J].肝胆胰外科杂志, 2012, 24(1):5-7.
16.	罗昆仑, 方征, 董志涛, 等.腹腔镜下胆囊三角区结构变异的认识与处理[J].中国微创外科杂志, 2009, 9(8):720-721.
17.	Wu YV, Linehan DC. Bile duct injuries in the era of laparoscopic cholecystectomies[J]. Surg Clin North Am, 2010, 90(4):787-802.
18.	de Reuver PR, Rauws EA, Brumo MJ, et al. Survival in bile duct injury patients after laparoscopic cholecystectomy:a multi-disciplinary approach of gastroenterologists, radiologists, and surgeons[J]. Surgery, 2007, 142(1):1-9.
19.	de Reuver PR, Grossmann I, Busch OR, et al. Referral pattern and t iming of repair are risk factors for complications after recons-tructive surgery for bile duct injury[J]. Ann Surg, 2007, 245(5):763-770.
20.	Sikora SS, Pottakkat B, Srikanth G, et al. Postcholecystectomy benign biliary strictures-long-term results[J]. Dig Surg, 2006, 23(5-6):304-312.
21.	张永杰.感染性胆道损伤的再手术治疗[J].中国实用外科杂志, 2006, 26(3):173-176.
22.	Thomson BN, Parks RW, Madhavan KK, et al. Early specialist repair of biliary injury[J]. Br J Surg, 2006, 93(2):216-220.
23.	董家鸿.医源性胆道损伤及损伤性胆管狭窄的现代外科处理[J].中华消化外科杂志, 2008, 7(1):6-8.
24.	姜洪池, 高越.医源性胆道损伤的不可忽视性及其防治策略[J].中华肝胆外科杂志, 2005, 11(3):152-154.
25.	杨坚, 苗雄鹰, 陈湘平, 等. 49例腹腔镜胆囊切除术所致医源性胆管损伤的处理[J].中国现代手术学杂志, 2013, 17(3):181-183.
26.	张永杰.如何掌握胆管损伤后再手术时间[J].肝胆外科杂志, 2004, 12(3):166-168.
27.	黄强, 刘臣海, 王成, 等.梗阻性胆道损伤修复时机的实验研究[J].实用医学杂志, 2011, 27(3):389-391.
28.	Slater K, Strong RW, Wall DR, et al. Iatrogenic bile duct injury:the sourage of laparoscopic cholecystectomy[J]. ANZ J Surg, 2002, 72(2):83-88.
29.	李徽, 李全辉, 陈雨信.胆道空肠Roux-en-Y吻合术[J].中华现代外科学杂志, 2008, 5(8):591-592.
30.	范爱国, 张富, 杨国兴.空肠人工瓣膜成形在胆道Roux-en-Y吻合术中的应用[J].中国现代普通外科进展, 2011, 14(7):566-567.
31.	郭永生, 张卫东.特殊术后病人的介入辅助治疗3例[J].现代保健:医学创新研究, 2007, 4(36):45-46.
32.	谷化剑, 冯贤松, 辛小燕.医源性胆道损伤的原因分析与防治策略[J].中国普通外科杂志, 2013, 22(2):192-196.
33.	Ardiles V, MeCormack L, Quiñonez E, et al. Experience using liver transplantation for the treatment of severe bile duct injuries over 20 years in Argentina:results from a National Survey[J]. HPB(Oxford), 2011, 13(8):544-550.
34.	Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures[J]. J Am Coll Surg, 2008, 206(5):918-923.

1. Tantia O, Jain M, Khanna S, et al. Iatrogenic biliary injury:13305 cholecystectomies experienced by a single surgical team over more than 13 years[J]. Surg Endosc, 2008, 22(4):1077-1086.
2. Törnqvist B, Strömberg C, Presson G, et al. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival aftercholecystectomy:population based cohort study[J]. BMJ, 2012, 345):e6457.
3. 秦乐运.冲吸钝性解剖法防止腹腔镜胆囊切除术中胆道损伤的应用心得[J].中国中西医结合外科杂志, 2013, 19(2):203-204.
4. 中华医学会外科学分会胆道外科学组.胆管损伤的诊断与治疗指南(2013版)[J].中华消化外科杂志, 2013, 12(2):81-95.
5. 郭盖章.腹腔镜胆囊切除术并发症28例教训分析[J].肝胆外科杂志, 2009, 17(6):451-452.
6. 黄志强.医源性胆管狭窄:胆道外科之痛[J].中华消化外科杂志, 2008, 7(1):1-5.
7. 陆秀泽.医源性胆管损伤中机械性损伤与热力损伤的临床治疗观察[J].中国医疗前沿, 2013, 8(10):37, 42.
8. 李良, 鲁俊, 张军, 等.腹腔镜胆总管切开取石在老年胆道结石患者中的应用[J].中华全科医学, 2011, 9(7):1037-1039.
9. 方金满, 潘文, 许先军, 等.胆囊切除相关性胆道损伤的诊治分析[J].肝胆外科杂志, 2013, 21(1):48-50.
10. 刘金钢.腹腔镜胆囊切除术中医源性胆管损伤的预防[J].中国实用外科杂志, 2011, 31(7):571-573.
11. 刘刚峰.胆囊切除术中胆道损伤的预防[J].中国临床研究, 2013, 26(6):581-582.
12. 刘群, 郭琪, 梁晓燕, 等.胆囊管正常变异的X线分析及临床意义[J].实用放射学杂志, 2002, 18(1):20-22.
13. 汪丽伟. 31例医源性胆管损伤诊疗体会[J].中国伤残医学, 2013, 21(4):111-112.
14. 袁德汗, 陈应军, 卫洪波, 等.腹腔镜胆囊切除术所致胆道损伤的相关危险因素分析[J].中国内镜杂志, 2013, 19(5):492-495.
15. 林擎天.医源性胆管损伤的诊治[J].肝胆胰外科杂志, 2012, 24(1):5-7.
16. 罗昆仑, 方征, 董志涛, 等.腹腔镜下胆囊三角区结构变异的认识与处理[J].中国微创外科杂志, 2009, 9(8):720-721.
17. Wu YV, Linehan DC. Bile duct injuries in the era of laparoscopic cholecystectomies[J]. Surg Clin North Am, 2010, 90(4):787-802.
18. de Reuver PR, Rauws EA, Brumo MJ, et al. Survival in bile duct injury patients after laparoscopic cholecystectomy:a multi-disciplinary approach of gastroenterologists, radiologists, and surgeons[J]. Surgery, 2007, 142(1):1-9.
19. de Reuver PR, Grossmann I, Busch OR, et al. Referral pattern and t iming of repair are risk factors for complications after recons-tructive surgery for bile duct injury[J]. Ann Surg, 2007, 245(5):763-770.
20. Sikora SS, Pottakkat B, Srikanth G, et al. Postcholecystectomy benign biliary strictures-long-term results[J]. Dig Surg, 2006, 23(5-6):304-312.
21. 张永杰.感染性胆道损伤的再手术治疗[J].中国实用外科杂志, 2006, 26(3):173-176.
22. Thomson BN, Parks RW, Madhavan KK, et al. Early specialist repair of biliary injury[J]. Br J Surg, 2006, 93(2):216-220.
23. 董家鸿.医源性胆道损伤及损伤性胆管狭窄的现代外科处理[J].中华消化外科杂志, 2008, 7(1):6-8.
24. 姜洪池, 高越.医源性胆道损伤的不可忽视性及其防治策略[J].中华肝胆外科杂志, 2005, 11(3):152-154.
25. 杨坚, 苗雄鹰, 陈湘平, 等. 49例腹腔镜胆囊切除术所致医源性胆管损伤的处理[J].中国现代手术学杂志, 2013, 17(3):181-183.
26. 张永杰.如何掌握胆管损伤后再手术时间[J].肝胆外科杂志, 2004, 12(3):166-168.
27. 黄强, 刘臣海, 王成, 等.梗阻性胆道损伤修复时机的实验研究[J].实用医学杂志, 2011, 27(3):389-391.
28. Slater K, Strong RW, Wall DR, et al. Iatrogenic bile duct injury:the sourage of laparoscopic cholecystectomy[J]. ANZ J Surg, 2002, 72(2):83-88.
29. 李徽, 李全辉, 陈雨信.胆道空肠Roux-en-Y吻合术[J].中华现代外科学杂志, 2008, 5(8):591-592.
30. 范爱国, 张富, 杨国兴.空肠人工瓣膜成形在胆道Roux-en-Y吻合术中的应用[J].中国现代普通外科进展, 2011, 14(7):566-567.
31. 郭永生, 张卫东.特殊术后病人的介入辅助治疗3例[J].现代保健:医学创新研究, 2007, 4(36):45-46.
32. 谷化剑, 冯贤松, 辛小燕.医源性胆道损伤的原因分析与防治策略[J].中国普通外科杂志, 2013, 22(2):192-196.
33. Ardiles V, MeCormack L, Quiñonez E, et al. Experience using liver transplantation for the treatment of severe bile duct injuries over 20 years in Argentina:results from a National Survey[J]. HPB(Oxford), 2011, 13(8):544-550.
34. Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures[J]. J Am Coll Surg, 2008, 206(5):918-923.

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