胆囊切除术后良性胆管狭窄 - 孤立性肝内胆管狭窄：BISMUTH 分类的改良建议。
Post cholecystectomy benign biliary stricture-isolated hepatic duct stricture: a proposed modification of the BISMUTH classification.
机构信息
Department of HPB Surgery, Christian Medical College, Vellore, India.
Department of Radiodiagnosis, Christian Medical College, Vellore, India.
出版信息
ANZ J Surg. 2023 May;93(5):1306-1313. doi: 10.1111/ans.18281. Epub 2023 Jan 24.
BACKGROUND
Post-cholecystectomy, benign biliary strictures are challenging for both patients and surgeons. Bismuth classified benign biliary strictures into 5 types. This study aimed to review these isolated hepatic duct strictures which were not included in Bismuth classification.
METHODS
The case records of all patients who presented with post-cholecystectomy benign biliary strictures between January 2005 and December 2020 at our centre were reviewed. Data regarding demography, type of stricture, and treatment strategy were entered into the standard proforma.
RESULTS
There were 242 patients [type I-3.7%, type II-41.7%, type III-38.0%, type IV-6.6%, and type V-7.8%]. Five (2.1%) patients did not fit the Bismuth classification and were the focus of this study. In each of these patients, an isolated hepatic duct stricture (first-or second-order hepatic duct) was present, with no involvement of the common hepatic duct or hilar confluence.
CONCLUSIONS
The addition of isolated hepatic duct stricture [type VI] to the Bismuth classification will enhance the original classification, help in reporting and management of this sub-set of patients.
背景
胆囊切除术后，良性胆管狭窄给患者和外科医生都带来了挑战。Bismuth 将良性胆管狭窄分为 5 型。本研究旨在回顾这些未包含在 Bismuth 分类中的孤立性肝内胆管狭窄。
方法
回顾了 2005 年 1 月至 2020 年 12 月期间在我们中心就诊的所有因良性胆道狭窄而接受胆囊切除术后的患者的病历。将人口统计学、狭窄类型和治疗策略等数据录入标准表格。
结果
共有 242 例患者（I 型-3.7%，II 型-41.7%，III 型-38.0%，IV 型-6.6%，V 型-7.8%）。5 例（2.1%）患者不符合 Bismuth 分类，是本研究的重点。在这些患者中，均存在孤立性肝内胆管狭窄（一级或二级肝内胆管），不涉及肝总胆管或肝门汇合处。
结论
将孤立性肝内胆管狭窄（VI 型）纳入 Bismuth 分类，将增强原始分类，有助于报告和管理这组患者。
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