Lau Wan-Yee, Lai Eric C H
Department of Surgery, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Hepatobiliary Pancreat Dis Int. 2007 Oct;6(5):459-63.
Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury.
A Medline, PubMed database search was performed to identify relevant articles using the keywords "bile duct injury", "cholecystectomy", and "classification". Additional papers were identified by a manual search of the references from the key articles.
Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification.
None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.
医源性胆管损伤仍然是一个重要的临床问题，会给患者带来严重的发病率，甚至偶尔导致死亡。胆管损伤的处理难易程度、手术风险和预后差异很大，并且高度依赖于损伤的类型及其位置。本文回顾了胆管损伤的各种分类系统。
通过在Medline、PubMed数据库中检索关键词“胆管损伤”“胆囊切除术”和“分类”来识别相关文章。通过手动检索关键文章的参考文献确定了其他论文。
传统上，胆管损伤采用比氏（Bismuth）分类法进行分类。这种分类法起源于开放手术时代，旨在帮助外科医生选择合适的修复技术，并且与手术修复后的最终结果有良好的相关性。然而，比氏分类法并未涵盖所有可能的损伤类型。腹腔镜胆囊切除术中的胆管损伤往往比开放胆囊切除术中的更严重。斯特拉斯伯格（Strasberg）分类法通过纳入各种其他类型的肝外胆管损伤，使比氏分类法更加全面。我们团队、伯格曼（Bergman）等人、诺伊豪斯（Neuhaus）等人、森德斯（Csendes）等人以及斯图尔特（Stewart）等人也提出了其他分类系统以补充比氏分类法。
没有一种分类系统被普遍接受，因为每种分类系统都有其自身的局限性。希望在不久的将来能发布一种被普遍接受的综合分类系统。
