肝叶切除治疗复杂医源性胆管损伤1例报告并文献复习

Hepatic lobectomy for complex iatrogenic bile duct injury: a case report and review of the literature

摘要:

医源性胆管损伤（IBDI）是常见的胆管损伤类型，多发生于胆囊切除术。随着腹腔镜胆囊切除术的普及，其发生率明显高于开腹手术，且合并血管损伤（VI）的复杂病例逐渐增多，增加了诊治难度，严重时可导致肝缺血及萎缩。肝管空肠吻合术是胆管损伤后常用的重建方式，若合并VI，则可能需行肝切除。本文报告笔者收治的1例53岁女性患者，因胆囊切除术后出现胆汁漏入院。经2次多学科团队（MDT）讨论，术前评估显示肝右动脉及门静脉分支损伤并伴右前叶萎缩。根据术中所见，最终实施右半肝切除联合左肝管空肠Roux-en-Y吻合术。患者术后恢复顺利，随访6个月无明显不适。通过对该病例的诊治过程及文献的回顾与分析，本文总结了复杂IBDI的临床特点、诊治策略及MDT模式的价值，以期为临床实践提供借鉴。

Abstract:

Iatrogenic bile duct injury (IBDI) is a common type of bile duct injury, most frequently occurring during cholecystectomy. With the widespread use of laparoscopic cholecystectomy, its incidence is significantly higher than that of open surgery, and the number of complex cases combined with vascular injury (VI) has been increasing, posing greater challenges for diagnosis and treatment. In severe cases, it may result in hepatic ischemia and atrophy. Hepaticojejunostomy is the standard reconstructive procedure after bile duct injury, whereas hepatectomy may be required when VI is involved. We report the case of a 53-year-old woman who was admitted with bile leakage following cholecystectomy. After two multidisciplinary team (MDT) discussions, preoperative evaluation revealed injury to the right hepatic artery and a portal vein branch, accompanied by atrophy of the right anterior lobe. Based on intraoperative findings, the patient underwent right hepatectomy combined with Roux-en-Y hepaticojejunostomy of the left hepatic duct. Postoperative recovery was uneventful, and the patient remained symptom-free during a 6-month follow-up. By reviewing the diagnosis and management of this case in conjunction with relevant literature, we summarize the clinical features, treatment strategies, and the value of MDT management in complex IBDI, aiming to provide reference for clinical practice.