胆道良性狭窄.pptVIP

**Stagingsystemshavebeendevelopedforstricturesduetooperativetrauma,cholangiocarcinoma,andHIVdisease.Thechoiceofoperativerepairofabileductstricturedependsonthelocationofthestricture.StricturesinvolvingtheCBDandlowcommonhepaticductareeasiertorepaircomparedtostricturesthataremoreproximal.**Type1:Thisisalowcommonhepaticductstricture.Atleast2cmofthehepaticductisintact.Type2:Thisisamidcommonhepaticductstricture.Thehepaticductstumpissmallerthan2cm.Type3:Thisisahilarstricture.Thecommonhepaticductisnotinvolved,buttheconfluenceofrightandlefthepaticductsisintact.Type4:Inthistype,thehilarconfluenceisdestroyed.Therightandlefthepaticductsareseparated.Type5:Theaberrantrightsectorialductisinvolved,aloneorwiththeCBD.**Iatrogenicbiliarylesionsrepresentacomplexandchallengingsurgicalproblem.Largepartoftheselesionsoccurduringcholecystectomyandthesepatientsarefrequentlyyoungandgenerallyexpectasimpleclinicalcourseandimmediaterecovery.

Withthelargespreadingoflaparoscopiccholecystectomyinthelastdecade,thefrequencyofiatrogeniclesionsofthebileducthaveincreasedramatically(0,5%),buttheexactincidenceofbileductinjuryisreallyunknown,asmanycasesmaygounreportedinliterature.

DifferentkindsofbileductinjuryaredescribedduringcholecystectomyandtheyhavebeenrecentlyclassifiedbyStrasbergineighttypeswhichincludealsotheBismuthclassificationofbiliarystenosis(Fig.1,2).?Fig.1:Bismuthclassificationofbenignbileduct?stricturesbasedonthelocationofthelesioninrelationtothehepaticductbiforcation.??Fig.2:Strasbergclassificationoflaparoscopic?injuriestothebiliarytract.TypeAinjuriesoriginatefromsmallbileductsthatareenteredintheliverbedorfromthecysticduct.TypeBandTypeCinjuriesaremostalwaysinvolved?