医源性胆管损伤的确定性手术修复时机

摘要

Proper timing of repair is one of key factors predicting long-term prognosis of iatrogenic biliary injury.Local inflammation is proved related to long-term biliary stricture.This article introduces pathological procedure of biliary injury based on pathophysiological mechanism and animal model rescarch of wound healing,and how to increase intraoperative repair rate based on the clinical evidences.The preoperative active inflammation control and systemic management could create necessary conditions for the the subsequent early repair.At the same time,authors suggest to set individual strategy regarding timing of repair.Delayed repair is recommended for combined vascular injury or severe biliary injury with terrible contamination.%医源性胆管损伤恰当的手术修复时机是影响患者远期预后的关键因素,损伤局部的炎症反应状态与远期胆管狭窄明确相关.笔者从医源性胆管损伤修复的病理生理学机制、损伤动物模型探讨胆管损伤组织病理学改变过程,结合现有临床研究证据探讨如何提高术中修复率.对合适的病例,术前主动控制局部炎症反应和全身管理十分重要,为行早期修复创造条件.同时,修复时机的选择应兼顾个体化原则,对合并血管损伤或污染严重患者仍应行延迟修复.