Abstract:

The update of the treatment concepts, modes and techniques of iatrogenic bile duct injury        DONG Jia-hong，ZENG Jian-ping. Department of Hepato-biliary-pancreatic Surgery，Beijing Tsinghua Changgung Hospital，Medical Center，Tsinghua University，Beijing 102218, China
Corresponding author：DONG Jia-hong，E-mail：dongjh301@163.com
Abstract    During more than one hundred years，many concepts and techniques of iatrogenic bile duct injury have been developed and updated. A variety of classification systems have been developed，especially the Chinese classification based on the clinical pathological features of injuries，which lays the foundation for a rational selection of treatment strategies. The timing of repair was formulated according to local inflammatory conditions and early repair was recommended. The biliary reconstruction should be build on "healthy bile ducts without inflammation，ischemia and scarring" and used the technique of "mucosal-mucosal anastomosis". EEA （end to end anastomosis） and heptatojejunostomy were established as the basic surgical methods of biliary tract reconstruction. The new concepts and techniques have been significantly improved the long-term outcome of definitive repair of bile duct injury. The application of endoscopic technology enables minor bile duct injury to be cured by non-surgical treatment.    Hepatectomy and liver transplantation provides a reliable cure for severe injury and end-stage bile disease secondary to injury. The modes of specialist repair and multi-disciplinary treatment provide scientific guarantees for the rational formulation of individualized treatment strategies and fully optimizes the therapeutic effect. In the future，systematic research on the injury pathology，clinical classification，treatment strategies，and comprehensive application of diversified methods will effectively promote the establishment of precision medicine system for bile duct injury，thereby further improving the outcome of definitive treatments.

Key words: iatrogenic bile duct injury, classification system, timing of repair, definitive treatment, multi-disiplinary team

摘要：

医源性胆管损伤的治疗历经百余年，发展和更新了诸多理念、模式和技术。先后制定了多种胆管损伤分型系统，尤其是以损伤临床病理学特征为依据的中国分型，为合理选择治疗策略奠定了基础。确立了以损伤局部炎症状态为依据的术中修复、早期修复和延迟修复的个体化手术时机；确立了“建立在无炎症、无缺血、无瘢痕的健康胆管”以及“黏膜对黏膜吻合”的胆道重建原则，形成以胆管对端吻合和胆管空肠吻合为基本术式的胆道重建方法，显著提高了医源性胆管损伤确定性手术修复的远期疗效。内镜诊疗技术的应用使得轻微胆管损伤可以通过非手术治疗获得痊愈，肝切除与肝移植技术的引入为严重肝胆管损伤及损伤继发的终末期胆病提供了可靠的治愈手段。专科治疗和多学科综合治疗协作组模式的确立，为合理制定个体化治疗策略提供了科学的保障，全面优化了医源性胆管损伤的治疗效果。未来，针对胆管损伤病理学、临床分型、治疗策略、多元化方法综合应用的系统研究，将推动胆管损伤治疗精准医疗体系的建立，从而进一步提高胆管损伤的治疗效果。

关键词: 医源性胆管损伤, 分型系统, 手术时机, 确定性治疗, 多学科综合治疗协作组