胆囊切除术胆道损伤20例的Strasberg分型、处理与预后

目的探讨胆囊切除术致胆道损伤的Strasberg分型、处理与预后的关系。方法回顾性分析近8年间收治的胆囊切除术后胆道损伤病人的临床资料和Strasberg分型。结果按胆道损伤Strasberg分型标准，20例中A型7例，非手术治疗有效，恢复良好；D型4例，均为术中发现，行胆管修补，随访良好；E1型1例，术后外引流，3个月后择期行胆肠吻合术，随访良好；E2型2例，术中发现，行胆肠吻合术，随访良好；E3型3例，其中1例术中行肝胆管空肠吻合术，随访良好，另2例3个月后择期行胆肠吻合术，1例恢复不良；E4型3例，均择期行胆肠吻合，1例恢复不良。结论胆囊切除术致胆道损伤疗效取决于损伤的类型，术中、术后正确处理，以及专科医生参与。

Strasberg classification, treatment and prognosis for bile duct injury following cholecystectomy

Objective To explore the Strasberg type and treatment of bile duct injury （BDI） following cholecystectomy. Methods Clinical data of 20 cases of BDI following cholecystectomy were analyzed retrospectively. Results For Straberg classification, there were 7 cases of type A, 4 cases of type D, one case of type E1, 2 cases of type E2, 3 cases of type E3, and 3 cases of type E4. Patients with BDI of type A were cured after drainage. Patients with BDI of type D received ＂immediate repair＂ and cured. One with BDI of type E1 received ＂elective repair＂, cholangioenterotic anastomosis, and cured. Two with BDI of type E2 received ＂immediate repair＂, cholangioenterotic anastomosis, and cured. Of 3 cases of BDI of type E3 BDI, one received ＂immediate repair＂, cholangioenterotic anasto- mosis, and cured; two received elective cholangioenterotic anastomosis, one cured and one developed cholangiotitis. Three with BDI of type E4 received elective cholangioenterotic anastomosis, two cured and one developed cholangiotitis. Conclusion The optimal management depends on the timing of recognition of injury, the extent of BDI, the patients condition and the availability of experienced hepatobiliary surgeons.