关键词: 腹腔镜胆囊切除术, 胆管损伤, 修复手术, 时机

Abstract:

Timing of surgical repair after iatrogenic bile duct injury          LIANG Ting-bo, MA Tao. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
Corresponding author: LIANG Ting-bo，E-mail:liangtingbo@
zju.edu.cn
Abstract    Iatrogenic bile duct injury （BDI） is a relatively common complication of laparoscopic cholecystectomy （LC）. Surgical repair is the best choice for severe BDI including transection of major bile ducts. However，the timing of repairing operation is still controversial.There is little debate that prompt repair should be done by experienced surgeons if BDI is discovered during LC.It’s also recommended that simple drainage of the abdomen and referral to an experienced tertiary care center if the conditions for an optimal treatment are not available.BDI discovered post-LC is more common.Delayed repair is traditionally preferred over early repair as the success rate of repair is higher when local inflammation and sepsis are controlled. However，recent data reveal that early repair may shorten length of hospital stay and decrease the medical cost，without increasing surgical risks and post-operative complications. The conflicting conclusions from different studies may be explained by the differentiation of indication for both treatment options，the severity of the injury and local inflammation response，and the general condition of the patient.In conclusion，the timing of surgical repair for BDI should be tailored according to the local and general conditions of the patient. An individualized approach is recommended to improve the success rate of repair and the quality of life，and to decrease the length of hospital stay and medical cost.

Key words: laparoscopic cholecystectomy, bile duct injury, surgical repair, timing