ABSTRACT
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.
ABSTRACT
Objective To study the effect of applying gastro-bile duct drainage in iatrogentic injury in the bile duct and reasons of iatrogentic injury in the bile duct. Methods Clinical data of 9 cases with iatrogentic injury in the bile duct were studied retrospectively. Results Nine patients with iatrogentic injury in the bile duct were found in time by affnsion examination, choledochoendoscopy or cholangiography intraoperation, including 5 cases in-jured by metal divining rod,2 cases caused by lithotomy, 1 case injured by laparoscopic elastic separating plier and 1 case injured by common hepatic duct transection. The gastro-bile duct was placed into common bile duct through pa-pilla of duodenum, pylorus and the former wall of gastric. All the cases recovered smoothly. The gastro-bile duct was removed in 8 cases in 6 to 10 days later,in 1 cases in 30 days later,who were followed up for 9 months to 5 years, finding no complications such as stricture of bile duct and retroperitoneal infection. Conclusions Intraoperative cho-ledochoendoacopy,affusion examination and cholangiography are helpful to diagnosis. The better results are achieved by appling gastro-bile duct drainage in iatrogentic injury in the bile duct.