Bektas H, Schrem H, Winny M, Klempnauer J
Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, D-30625 Hanover, Germany.
Br J Surg. 2007 Sep;94(9):1119-27. doi: 10.1002/bjs.5752.
Different injury patterns of iatrogenic bile duct lesions after cholecystectomy have prompted the proposal of several different clinical classification systems. The aim of this study was to validate these systems comparatively.
Results after surgical intervention for iatrogenic bile duct lesions in 74 consecutive patients at a tertiary referral centre were reviewed retrospectively. A new classification (Hannover classification) for iatrogenic bile duct lesions is proposed and compared with four other systems using the present clinical data.
Additional vascular lesions were found in 19 per cent. The hospital mortality rate was 3 per cent and the overall hospital complication rate after repair was 26 per cent. Sixteen of 74 patients required early surgical reintervention. The Hannover classification demonstrated a highly significant association between the discrimination of classifiable injury patterns and the different surgical treatments chosen (P < 0.005). The Strasberg and Neuhaus classifications do not consider vascular involvement, whereas the Stewart-Way, Siewert and Neuhaus systems do not discriminate between lesions at or above the bifurcation of the hepatic duct.
Additional vascular involvement and location of the lesion at or above the bifurcation of the hepatic duct have a major impact on the extent of surgical intervention required and should be reflected in any classification of bile duct injuries.
胆囊切除术后医源性胆管损伤的不同损伤模式促使人们提出了几种不同的临床分类系统。本研究的目的是对这些系统进行比较验证。
回顾性分析一家三级转诊中心连续74例医源性胆管损伤患者的手术干预结果。提出了一种医源性胆管损伤的新分类（汉诺威分类），并将其与其他四种系统利用当前临床数据进行比较。
发现19%的患者伴有血管损伤。医院死亡率为3%，修复后的总体医院并发症发生率为26%。74例患者中有16例需要早期手术再次干预。汉诺威分类显示，可分类损伤模式的区分与所选择的不同手术治疗之间存在高度显著的相关性（P<0.005）。斯特拉斯伯格分类法和诺伊豪斯分类法未考虑血管受累情况，而斯图尔特-韦分类法、西韦特分类法和诺伊豪斯分类法未区分肝管分叉处或其上方的病变。
额外的血管受累以及病变位于肝管分叉处或其上方，对所需手术干预的程度有重大影响，应在胆管损伤的任何分类中予以体现。
