Bile injury
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Hanover Bile ducts injury classification
![A grup
A grup periferinis tul転ies
tekjimas (turi ry邸眺 su
pagrindine tul転ies latak迭
sistema)
A1 i邸 tul転ies p笛sls latako
A2 i邸 tul転ies p笛sls guolio
Shown is an illustration of an iatrogenic bile duct lesion which is characterized by peripheral bile leakage with
connection to the main bile duct system. According to the Hanover Classification and as described and shown
previously [1], such a lesion would be labelled as a type A lesion (permission to use this figure has been
obtained from the publisher).](https://image.slidesharecdn.com/bileinjuryweb-130120041425-phpapp01/85/Bile-injury-9-320.jpg)
![B grup
B grup bendrojo tul転ies
latako stenoz
B1 nepilna
B2 pilna
Shown is an illustration of an iatrogenic bile duct lesion which is characterized by stenosis of the common bile
duct (ductus hepatocholedochus, DHC) which may be caused by a clip. According to the Hanover Classification
and as described and shown previously [1], such a lesion would be labelled as a type B lesion (permission to use
this figure has been obtained from the publisher).](https://image.slidesharecdn.com/bileinjuryweb-130120041425-phpapp01/85/Bile-injury-11-320.jpg)
![C grup
C grup
dalinis latako 眺pjovimas
C1 ma転as penetruojantis pa転eidimas (<5mm)
C2 i邸plits pa転eidimas 転emiau bifurkacijos
(>5mm)
C3 i邸plits pa転eidimas bifurkacijos lygyje
C4 i邸plits pa転eidimas auk邸iau bifurkacijos
Su kraujagysli迭 pa転eidimu (pvz.: C1d)
d de邸. kepen迭 arterija
s kair. kepen迭 arterjia
p savoji kepen迭 arterija
c tul転ies p笛sls arterija
pv kepen迭 vart迭 vena
Shown is an illustration of an iatrogenic bile duct lesion which is characterized by tangential injury of the common bile duct (ductus
hepatocholedochus, DHC) with or without additional vascular injury. According to the Hanover Classification and as described and shown
previously [1], such a lesion would be labelled as a type C lesion (permission to use this figure has been obtained from the publisher).](https://image.slidesharecdn.com/bileinjuryweb-130120041425-phpapp01/85/Bile-injury-13-320.jpg)
![D grup
D grup
Pilnai perpjautas tul転ies latakas
D1 転emiau bifurkacijos be defekto
D2 転emiau bifurkacijos su defektu
D3 bifurkacijos lygyje su/be defekto
D4 auk邸iau bifurkacijos su/be
defekto
Su kraujagysli迭 pa転eidimu:
d de邸. kepen迭 arterija
s kair. kepen迭 arterjia
p savoji kepen迭 arterija
c tul転ies p笛sls arterija
pv kepen迭 vart迭 vena
Shown is an illustration of an iatrogenic bile duct lesion which is characterized by complete transsection of the
common bile duct (ductus hepatocholedochus, DHC) with or without additional vascular injury. According to the
Hanover Classification and as described and shown previously [1], such a lesion would be labelled as a type D
lesion (permission to use this figure has been obtained from the publisher).](https://image.slidesharecdn.com/bileinjuryweb-130120041425-phpapp01/85/Bile-injury-15-320.jpg)
![E grup
E grup
Tul転ies latak迭 strikt笛ra
E1 cirkuliari strikt笛ra (<5mm)
E2 pailga strikt笛ra (>5mm)
E3 strikt笛ra bifurkacijos srityje
E4 de邸. kepen迭 latakas/
segmentinis latakas
Shown is an illustration of an iatrogenic bile duct lesion which is characterized by strictures of the common bile
duct (ductus hepatocholedochus, DHC). According to the Hanover Classification and as described and shown
previously [1] such a lesion would be labelled as a type E lesion (permission to use this figure has been obtained
from the publisher).](https://image.slidesharecdn.com/bileinjuryweb-130120041425-phpapp01/85/Bile-injury-18-320.jpg)
Bile injury
- 3. HANOVERIO JATROGENINI轍 TUL貼IES LATAK轍 SU貼ALOJIM轍 KLASIFIKACIJA Edgaras Kulikauskas Vilniaus universiteto Santari邸ki迭 klinikos Pilvo chirurgijos centras
- 4. 0,5 0,8%
- 5. Vienas i邸 150 - 200
- 6. 1982 1995 2000 Prof. Henri Bismuth MD Steven M. Strasberg Prof. Peter Neuhaus
- 7. Categorisation of patients with bile duct lesions and concomitant vascular injuries according to the Hanover Classification (d = A. hep. dex; s: a. hep. sin; p: a. hep. prop.; c: a. cystica; pv: portal vein; com: a. hepatica communis; DHC: common bile duct, ductus hepatocholedochus).
- 8. Hanoverio klasifikacija Prof. H端seyin Bektas
- 9. A grup A grup periferinis tul転ies tekjimas (turi ry邸眺 su pagrindine tul転ies latak迭 sistema) A1 i邸 tul転ies p笛sls latako A2 i邸 tul転ies p笛sls guolio Shown is an illustration of an iatrogenic bile duct lesion which is characterized by peripheral bile leakage with connection to the main bile duct system. According to the Hanover Classification and as described and shown previously [1], such a lesion would be labelled as a type A lesion (permission to use this figure has been obtained from the publisher).
- 10. Tul転ies tekjimas 4x Drenavimas arba tiesioginis A1 7 u転siuvimas su/be T drenu 3x hepatikojejunostomija ties BTL Drenavimas arba tiesioginis u転siuvimas su/be T drenu 66 % teorijos ir praktikos sutapimas 1x kepen迭 segmentektomija A2 5 4x Drenavimas arba tiesioginis u転siuvimas su/be T drenu
- 11. B grup B grup bendrojo tul転ies latako stenoz B1 nepilna B2 pilna Shown is an illustration of an iatrogenic bile duct lesion which is characterized by stenosis of the common bile duct (ductus hepatocholedochus, DHC) which may be caused by a clip. According to the Hanover Classification and as described and shown previously [1], such a lesion would be labelled as a type B lesion (permission to use this figure has been obtained from the publisher).
- 12. BTL stenoz 1 x bifurkacijos rezekcija ir B1 1 hepatikojejunostomija Kabi迭 pa邸alinimas, drenavimas ir stentavimas arba drenavimas T-drenu. Nekrozavus latako sienelei: rezekcija ir pirmin rekonstrukcija ar 2x bifurkacijos rezekcija ir hepatikojejunostomija. hepatikojejunostomija 75 % teorijos ir praktikos B2 3 1x de邸inioji kepen迭 rezekcija ir sutapimas. bifurkacijos rezekcija su hepatikojejunostomija
- 13. C grup C grup dalinis latako 眺pjovimas C1 ma転as penetruojantis pa転eidimas (<5mm) C2 i邸plits pa転eidimas 転emiau bifurkacijos (>5mm) C3 i邸plits pa転eidimas bifurkacijos lygyje C4 i邸plits pa転eidimas auk邸iau bifurkacijos Su kraujagysli迭 pa転eidimu (pvz.: C1d) d de邸. kepen迭 arterija s kair. kepen迭 arterjia p savoji kepen迭 arterija c tul転ies p笛sls arterija pv kepen迭 vart迭 vena Shown is an illustration of an iatrogenic bile duct lesion which is characterized by tangential injury of the common bile duct (ductus hepatocholedochus, DHC) with or without additional vascular injury. According to the Hanover Classification and as described and shown previously [1], such a lesion would be labelled as a type C lesion (permission to use this figure has been obtained from the publisher).
- 14. Dalinis latako pa転eidimas C1 1 1x hepatikojejunostomija BTL lygyje 3x hepatikojejunostomija BTL lygyje C2 5 2x PDR Pirmin rekonstrukcija su drenavimu ir tul転ies latak迭 stentavimu ar C2d 1 1 x hepatikojejunostomija BTL lygyje hepatikojejunostomija. Pa転eidus de邸. kepen迭 arterij paprastai 1x bifurkacijos rezekcija ir reikalinga kepen迭 rezekcija C3 2 hepatikojejunostomija 90% teorijos ir praktikos 1x hepatikojejunostomija BTL lygyje sutapimas. 1x bifurkacijos rezekcija ir C4 3 hepatikojejunostomija 2x hepatikojejunostomija BTL lygyje
- 15. D grup D grup Pilnai perpjautas tul転ies latakas D1 転emiau bifurkacijos be defekto D2 転emiau bifurkacijos su defektu D3 bifurkacijos lygyje su/be defekto D4 auk邸iau bifurkacijos su/be defekto Su kraujagysli迭 pa転eidimu: d de邸. kepen迭 arterija s kair. kepen迭 arterjia p savoji kepen迭 arterija c tul転ies p笛sls arterija pv kepen迭 vart迭 vena Shown is an illustration of an iatrogenic bile duct lesion which is characterized by complete transsection of the common bile duct (ductus hepatocholedochus, DHC) with or without additional vascular injury. According to the Hanover Classification and as described and shown previously [1], such a lesion would be labelled as a type D lesion (permission to use this figure has been obtained from the publisher).
- 16. Pilnai perpjautas tul転ies latakas 2x bifurkacijos rezekcija ir hepatikojejunostomija D1 7 4x hepatikojejunostomija BTL lygyje 1x de邸inioji hepatektomija ir bifurkacijos rezekcija ir hepatikojejunostomija 1x bifurkacijos rezekcija ir Pirmin latako rekonstrukcija D2 19 hepatikojejunostomija 18x hepatikojejunostomija BTL lygyje galas 眺 gal su stentavimu ir 2x hepatikojejunostomija BTL lygyje drenavimas arba 3x de邸inioji hepatektomija ir bifurkacijos hepatikojejunostomija. Pa転eidus D2d 6 rezekcija ir hepatikojejunostomija de邸. kepen迭 arterij paprastai 1x hepatikojejunostomija BTL lygyje su reikalinga kepen迭 rezekcija. de邸iniosios kepen迭 arterijos rekonstrukcija 72% teorijos ir praktikos 2x de邸inioji hepatektomija ir bifurkacijos rezekcija ir hepatikojejunostomija sutapimas. D3 7 4x de邸inioji hepatektomija ir bifurkacijos rezekcija ir hepatikojejunostomija 1x hepatikojejunostomija BTL lygyje 1x hepatikojejunostomija BTL lygyje 1x bifurkacijos rezekcija ir D3d 2 hepatikojejunostomija su de邸. kepen迭 arterijos rekonstrukcija.
- 17. 1x de邸inioji kepen迭 rezekcija ir D3 d + pv 1 bifurkacijos rezekcija su hepatikojejunostomija 1x bifurkacijos rezekcija ir D3pv 1 hepatikojejunostomija Pirmin latako rekonstrukcija 2x hepatikojejunostomija BTL lygyje galas 眺 gal su stentavimu ir D4 9 7x bifurkacijos rezekcija ir drenavimas arba hepatikojejunostomija hepatikojejunostomija. Pa転eidus de邸. kepen迭 arterij paprastai D4c 1 1x kepen迭 segmentektomija reikalinga kepen迭 rezekcija. 72% teorijos ir praktikos 4x de邸inioji kepen迭 rezekcija ir sutapimas. bifurkacijos rezekcija su D4d 6 hepatikojejunostomija 2x bifurkacijos rezekcija ir hepatikojejunostomija 2x de邸inioji kepen迭 rezekcija ir D4d + pv 2 bifurkacijos rezekcija su hepatikojejunostomija
- 18. E grup E grup Tul転ies latak迭 strikt笛ra E1 cirkuliari strikt笛ra (<5mm) E2 pailga strikt笛ra (>5mm) E3 strikt笛ra bifurkacijos srityje E4 de邸. kepen迭 latakas/ segmentinis latakas Shown is an illustration of an iatrogenic bile duct lesion which is characterized by strictures of the common bile duct (ductus hepatocholedochus, DHC). According to the Hanover Classification and as described and shown previously [1] such a lesion would be labelled as a type E lesion (permission to use this figure has been obtained from the publisher).
- 19. Tul転ies latak迭 strikt笛ra E1 0 Stentavimas arba 3x hepatikojejunostomija BTL E2 3 lygyje hepatikojejunostomija 100% teorijos ir praktikos 1x bifurkacijos rezekcija ir sutapimas E3 1 hepatikojejunostomija E4 0
- 20. I邸vados Hanoverio klasifikacija yra viena i邸 daugelio Pana邸i 眺 m笛s迭 naudojam Neuhaus klasifikacij 町traukia kraujagysli迭 pa転eidimus Remiantis 邸ia klasifikacija galima parinkti pa転eidimo tipui specifin眺 gydym
- 21. AI的 U貼 DMES町