Beata Jabłońska, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, 40-752 Katowice, Poland.
World J Gastroenterol. 2013 Oct 14;19(38):6348-52. doi: 10.3748/wjg.v19.i38.6348.
Iatrogenic bile duct injuries (IBDI) are still a challenge for surgeons. The most frequently, they are caused by laparoscopic cholecystectomy which is one of the commonest surgical procedure in the world. Endoscopic techniques are recommended as initial treatment of IBDI. When endoscopic treatment is not effective, surgery is considered. Different surgical biliary reconstructions are performed in most patients in IBDI. Roux-Y hepaticojejunostomy is the commonest biliary reconstruction for IBDI. In some patients with complex IBDI, hepatectomy is required. Recently, Li et al analyzed the factors that had led to hepatectomy for patients with IBDI after laparoscopic cholecystectomy (LC). Authors concluded that hepatectomy might be necessary to manage early or late complications after LC. The study showed that proximal IBDI (involving hepatic confluence) and IBDI associated with vascular injuries were the two independent risk factors of hepatectomy in this series. Authors distinguished two main groups of patients that require liver resection in IBDI: those with an injury-induced liver necrosis necessitating early intervention, and those in whom liver resection is indicated for treatment of liver atrophy following long-term cholangitis. In this commentary, indications for hepatectomy in patients with IBDI are discussed. Complex biliovascular injuries as indications for hepatectomy are presented. Short- and long-term results in patients following liver resection for IBDI are also discussed. Hepatectomy is not a standard procedure in surgical treatment of IBDI, but in some complex injuries it should be considered.
医源性胆管损伤 (IBDI) 仍然是外科医生面临的挑战。最常见的原因是腹腔镜胆囊切除术，这是世界上最常见的手术之一。推荐内镜技术作为 IBDI 的初始治疗方法。当内镜治疗无效时，考虑手术。大多数 IBDI 患者需要进行不同的胆道重建手术。Roux-Y 肝肠吻合术是 IBDI 最常见的胆道重建方法。在一些复杂的 IBDI 患者中，需要进行肝切除术。最近，Li 等人分析了腹腔镜胆囊切除术后 (LC) 导致 IBDI 患者行肝切除术的因素。作者得出结论，肝切除术可能是管理 LC 后早期或晚期并发症所必需的。该研究表明，近端 IBDI（涉及肝汇合处）和伴有血管损伤的 IBDI 是本系列中肝切除术的两个独立危险因素。作者将需要行肝切除术的 IBDI 患者分为两组：一组是因损伤导致肝坏死需要早期干预的患者，另一组是因长期胆管炎导致肝萎缩需要行肝切除术的患者。在本评论中，讨论了 IBDI 患者行肝切除术的适应证。提出了复杂的肝胆血管损伤作为肝切除术的适应证。还讨论了 IBDI 患者行肝切除术后的短期和长期结果。肝切除术不是 IBDI 外科治疗的标准程序，但在某些复杂损伤中应考虑。
