探讨医源性胆管损伤（IBDI）诊治经验。

回顾性分析2016年1月至2017年4月在新疆维吾尔自治区人民医院行肝切除术的2例IBDI患者临床资料。例1女，62岁，因LC术后3 d出现发热、黄疸。例2女，44岁，因LC术后即出现皮肤、黏膜黄染。2例均诊断为"梗阻性黄疸，IBDI"。2例患者均签署知情同意书，符合医学伦理学规定。

例1患者于超声引导下行胆管穿刺引流术，1个月后出现腹痛、腹胀、食欲减退等不适。CT示肝内多发低密度灶，考虑肝脓肿。行"右半肝切除+肝胆管-空肠吻合术"。例2患者完善术前准备后行"剖腹探查+胆管-空肠吻合术"，2个月后患者出现发热，CT示肝脓肿，CT血管造影（CTA）示肝右动脉假性动脉瘤。经多学科讨论后行"右半肝切除术+左肝管-空肠吻合术"。2例患者术后恢复顺利，出院后随访6个月无明显并发症发生。

对于IDBI患者，应行CTA检查有否合并肝右动脉损伤，如有损伤应及时重建，无法重建应考虑胆管修复的同时行右半肝切除；肝右动脉损伤未能重建血运者，术后应严密观察病情变化，及时发现肝右叶坏死及肝脓肿，行右半肝切除术。

To investigate the experience of diagnosis and treatment of iatrogenic bile duct injury (IBDI).

Clinical data of 2 patients with IBDI who underwent hepatectomy in the People's Hospital of Xinjiang Uygur Autonomous Region between January 2016 and April 2017 were retrospectively analyzed. Case 1 was a 62-year-old female, presented with fever and jaundice 3 d after laparoscopic cholecystectomy (LC). Case 2 was a 44-year-old female, presented with yellow skin and mucosa 3 d after LC. Both patients were diagnosed with obstructive jaundice and IBDI. The informed consents of two patients were obtained and the local ethical committee approval was received.

Case 1 underwent ultrasound-guided transhepatic biliary drainage, and suffered from abdominal pain, abdominal distension and anorexia 1 month later. Computed tomography (CT) scan revealed multiple intrahepatic hypodense lesions, which were considered as liver abscess. Right hemihepatectomy combined with intrahepatic cholangiojejunostomy was performed in Case 1. Case 2 underwent exploratory laparotomy and cholangiojejunostomy after well preoperative preparations. The patient suffered from fever after 2 month. CT scan revealed liver abscess, CT angiography (CTA) revealed a pseudoaneurysm in the right hepatic artery. After multi-disciplinary consultation, right hemihepatectomy combined with left hepaticojejunostomy was performed. Two patients recovered well. No significant complication was observed in the patients during the 6-month follow-up after discharged from hospital.

For IDBI patients, CTA should be performed to check if complication of right hepatic artery injury exists. Revascularization should be performed timely. If it cannot be revascularized, bile duct repairing and right hemihepatectomy can be performed simultaneously. For patients with right hepatic artery injury which cannot be revascularized, postoperative conditions should be closely observed. Right hemihepatectomy should be performed timely when necrosis and liver abscess are detected in the right lobe.