医源性胆管损伤防治进展与现状

doi:10.3877/cma.j.issn.2095-3232.2025.03.003

医源性胆管损伤（IBDI）系外科手术或其他有创性诊疗操作治疗过程中，因医源性因素造成的胆管损伤。随着腹腔镜技术的不断发展，腹腔镜胆囊切除术（LC）已成为胆囊良性疾病治疗的“金标准”，但其引起的意外胆管损伤在各级医院仍时有发生，并成为IBDI最常见的病因。如果IBDI诊断不及时、治疗不恰当，即可导致胆汁性腹膜炎、胆道感染、胆管狭窄、胆汁性肝硬化、终末期肝病等严重并发症，甚至引起患者死亡。因此，准确把握IBDI 的病因、诊断、分型、修复时机、治疗方式、预防措施尤为重要。本文就IBDI 的研究进展与现状做一述评，以期指导临床充分明确IBDI 病因、及时做出准确诊断、严格判断损伤分型、合理确定修复时机、精准采取治疗方式、切实加强预防措施，从而进一步提高IBDI防治效果。

关键词: 医源性胆管损伤, 分型, 诊断, 治疗, 预防

Iatrogenic bile duct injury （IBDI） refers to bile duct injury caused by iatrogenic factors during surgery or alternative invasive diagnosis and treatment procedures. With persistent development of laparoscopic technique， laparoscopic cholecystectomy （LC） has become the “gold standard” for the treatment of benign gallbladder diseases. However， accidental bile duct injuries caused by LC occasionally occur in hospitals at all levels and become the most common cause of IBDI. If IBDI were not timely diagnosed or properly treated， it will lead to serious complications such as biliary peritonitis， biliary tract infection， bile duct stenosis， biliary cirrhosis and end-stage liver disease， and even death. Therefore， accurate understanding of the etiology， diagnosis， classification， opportunity for repair， treatment and preventive measures of IBDI plays a significant role. In this article， research progress and current status of IBDI were reviewed， aiming to provide guidance for clinicians to fully unravel the etiology of IBDI， make accurate and timely diagnosis，strictly assess the classification of injury， reasonably determine the opportunity for repair， adopt precise treatment and effectively strengthen preventive measures， thereby further enhancing prevention and treatment effects for IBDI.

Key words: Iatrogenic bile duct injury (IBDI), Classification, Diagnosis, Treatment, Prevention

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Progress and current status of prevention and treatment of iatrogenic bile duct injury

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Progress and current status of prevention and treatment of iatrogenic bile duct injury