Diagnosis and treatment experience of bile duct injury caused by laparoscopic cholecystectomy
10.3877/cma.j.issn.2095-3232.2016.06.012
- VernacularTitle:腹腔镜胆囊切除术胆管损伤诊治经验
- Author:
Shufan LI
1
;
Jiwei XU
;
Huadong ZENG
;
Yuanzhang WEN
Author Information
1. 514031,广东省梅州市人民医院肝胆外一科
- Keywords:
Cholecystectomy,laparoscopic;
Bile ducts;
Therapeutic uses
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2016;5(6):394-397
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the diagnosis, treatment and prevention method for bile duct injury caused by laparoscopic cholecystectomy (LC). Methods Clinical data of 16 patients with iatrogenic bile duct injury caused by LC in Meizhou People's Hospital of Guangdong Province between January 2007 and January 2013 were retrospectively analyzed. Among them, 7 were males and 9 were females, aged 28-75 years old with a median age of 47 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The types of bile duct injury were classified according to the Strasberg bile duct injury classification. Treatments and postoperative clinical manifestations were analyzed, and clinical efficacy was observed. Results Among 16 patients, 9 were converted to open surgery during the surgery, and 7 underwent open surgery within 2 weeks after LC. There were 2 cases of type A bile duct injury, 7 of type D, 2 of type E1, 3 of type E2 and 2 of type E4. Two cases underwent bile duct repair alone, 1 underwent bile duct repair and stage Ⅱ endoscopic retrograde cholangiopancreatography (ERCP) balloon dilatation, 4 underwent bile duct repair + T tube drainage, 3 underwent bile duct anastomosis + T tube drainage, and 7 underwent Roux-en-Y anastomosis. One case died from multiple organ failure in the perioperative period. Recurrent mild biliary tract infection was observed in 1 case after surgery, biliary tract stenosis in 1 case and obstructive jaundice in 1 case, and all the other patients recovered. Conclusions For the bile duct injury caused by LC, surgeons should not only be familiar with the early diagnosis method, clinical classification and surgical treatment principles for iatrogenic bile duct injury, but also possess the capacity of coping with emergenices. During the surgery, surgeons should carefully identify the relationship among cystic duct, common bile duct and gallbladder ampulla, and perform precisely. Early diagnosis and appropriate treatment also play an important role.
