Analysis of the diagnosis and treatment of 68 cases of iatrogenic ureteral stricture / 现代泌尿外科杂志

【Objective】 To investigate the common etiology, characteristics and treatment of iatrogenic ureteral stricture. 【Methods】 The clinical data of 226 patients with ureteral stricture repaired during May 2019 and Mar. 2022 were retrospectively analyzed, including 68 cases of iatrogenic ureteral stricture. According to the etiology, the patients were divided into urinary group and non-urinary group. 【Results】 There were 42 females and 26 males, aged 25 to 67 (average 49.0±10.4) years. Upper ureteral stricture was detected in 24 (35.3%) cases, who received oral mucosal repair of the ureter. Middle ureteral stricture was detected in 12 (17.6%) cases, who underwent ileal ureterography. Lower ureteral stricture was observed in 24 (35.3%) cases, who were treated with vesical wall flap ureteroplasty. Full-length stricture was observed in 8 (11.8%) cases,who were treated with ileal ureterography. There were significant differences in age, gender, stenosis side, stenosis location and length, surgical methods and types between patients in the urinary group and non-urinary group (P<0.05). During the follow-up of 8 to 20 (average 12.3±5.6) months, the symptoms and renal function of all patients improved, and no recurrence occurred. 【Conclusion】 Invasive endourological surgery is the most common cause of iatrogenic ureteral stenosis. Different treatment strategies should be adopted according to patients’ condition, time of diagnosis and location and length of ureteral injury.

Treatment of iatrogenic injury to medial collateral ligament in total knee arthroplasty / 中华创伤骨科杂志

Objective:To explore the treatment of iatrogenic injury to the medial collateral ligament (MCL) in total knee arthroplasty (TKA).Methods:From January 2009 to December 2016, 14 patients were treated at Department of Arthropathy, Zhengzhou Orthopedics Hospital for iatrogenic MCL injury in primary TKA (injury group). They were 3 males and 11 females with an age of (72.6±3.9) years. The MCL injury was body rapture in 9 cases and avulsion of femoral insertion in 5 ones. Interlacing suture was used for body rapture and reparative reconstruction with wire anchors or nails was performed for avulsion of femoral insertion. A restrictive condylar prosthesis was used instead in the 4 patients whose medial stability failed to be restored after repair of body rapture. A control group of 21 cases was enrolled who had suffered from no iatrogenic MCL injury in primary TKA at the corresponding period. There were 5 males and 16 females with an age of (73.2±3.9) years. The 2 groups were compared in terms of American Knee Society Score (KSS) and knee flexion.Results:There was no significant difference between the 2 groups in preoperative general data, showing comparability between groups ( P>0.05). The injury group was followed up for 18 to 36 months (mean, 33 months). Joint loosening was observed at 18 months after operation in 3 patients with nonrestrictive prosthesis who had to receive secondary revision. At the 36-month follow-up of the remaining 11 patients, normal knee extension and flexion was observed, the stress test of valgus showed no inner relaxation, their KSS increased significantly from preoperative 50.0±22.7 to 93.3±4.7, and their knee flexion was improved significantly from 90.4°±10.3° to 110.7°±8.8° ( P<0.05). There were no significant differences in KSS score or knee flexion between the 2 groups at 3, 6, 12 or 36 months after operation ( P>0.05). Conclusion:Iatrogenic MCL injury in primary TKA should be repaired and reconstructed by one-stage surgery because the patients can achieve curative results similar to those for the patients free from iatrogenic MCL injury in primary TKA.

Anatomical study of the infrapatellar branch of the saphenous nerve with applications to knee surgery / Estudio anatómico de la rama infrapatelar del nervio safeno con aplicaciones a la cirugía de rodilla

The infrapatellar branch of the saphenous nerve is a cutaneous nerve that innervates the area surrounding the patella and contributes to the peripatellar plexus. This nerve is target to iatrogenic injuries during a great deal of knee procedures, such as tendon harvesting, total knee arthroplasty and medial arthroscopic approaches to the knee. Lesion to this nerve can produce sensorial loss at its innervation territory. The study conducted herein aims to observe the anatomical aspects of the infrapatellar branch in cadaveric specimens. The infrapatellar branch of the saphenous nerve of 40 male cadavers was dissected with the purpose of identifying the number of branches, its relation with the patella, tibial tuberosity and sartorius muscle. The nerve was dissected and several measurements were performed with the aid of a digital caliper. Statistical analysis was performed with the MedCalc 16.1 software. The infrapatellar branch of the saphenous nerve was present in 100 % of the sample. Its mean distance from its origin to its branching point was 16.35±6.48 mm on the right and 21.94±4.31 mm on the left, with statistically significant differences (p < 0.05). A relatively safe zone for surgery was observed on the superior and medial aspect of the patella, which received less branches.

La rama infrapatelar del nervio safeno es un nervio cutáneo que inerva el área que rodea la patela y contribuye al plexo peripatelar. Este nervio es objeto de lesiones iatrogénicas durante una gran cantidad de procedimientos de rodilla, como la extracción de tendones, la artroplastía total de rodilla y los abordajes artroscópicos mediales de la rodilla. La lesión de este nervio puede producir pérdida sensorial en su territorio de inervación. El estudio realizado aquí tiene como objetivo observar los aspectos anatómicos de la rama infrapatelar en muestras de cadáveres. La rama infrapatelar del nervio safeno de 40 cadáveres masculinos se disecó con el propósito de identificar el número de ramas, su relación con la patela, la tuberosidad tibial y el músculo sartorio. Se disecó el nervio y se realizaron varias mediciones con la ayuda de un calibrador digital. El análisis estadístico se realizó con el software MedCalc 16.1. La rama infrapatelar del nervio safeno estaba presente en el 100 % de las muestras. La distancia media desde su origen hasta su punto de ramificación fue de 16,35±6,48 mm a la derecha y de 21,94±4,31 mm a la izquierda, con diferencias estadísticamente significativas (p <0,05). Se identificó una zona relativamente segura para la cirugía en el aspecto superior y medial de la patela, que recibió menos ramas.

Stent Graft Implantation and Superselective Embolization with Liquid Embolic Agent, Onyx for Iatrogenic Common Iliac Artery Pseudoaneurysm and Persistant Endoleak

A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.

Surgical drainage versus repair in the treatment of distal common bile duct injury / 中华肝胆外科杂志

Objective To compare the efficacy of surgical drainage versus repair in the treatment of iatrogenic injury of the distal common bile duct detected during operation,and to evaluate the effect of gastrobiliary duct drainage.Methods Patients with iatrogenic choledochal injury were divided into two groups:the drainage group (n =17) and the repair group (n =7).Data on the amounts of postoperative biliary and abdominal cavity drainage,gastrointestinal function recovery,the duration of biliary drainage and hospitalization were compared.Results When compared with the repair group,there were no significant differences in the amounts of postoperative biliary drainage [(310.0± 112.0) vs.(264.0± 144.0) ml] and abdominal cavity drainage [(42.0±25.0) ml vs.(125.0± 195.0) ml)] (both P＞0.05).However,gastrointestinal function recovery [(3.0±1.5)d vs.(4.7±2.0)d],durations of biliary drainage [(7.5±1.0)d vs.(12.7±5.4)d] and hospitalization [(9.5±1.5)d vs.(15.1±5.6)d] of the drainage group were significantly shorter than the repair group (P＜ 0.05).No biliary strictures of cholangitis were detected in the two groups.Conclusion When compared with traditional repair,gastrobiliary drainage was a simpler,safer,and more effective therapeutic strategy for patients with iatrogenic distal common bile duct injury,and with a quicker recovery after treatment.

Comparative study on effect of different surgeries for vision and ocular tissues in leprosy patients with lagophthalmos / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To study the effect of different surgeries for vision and postoperative complications in leprosy patients with lagophthalmos.METHODS:A retrospective analysis.Totally 68 leprosy patients (97 eyes) with lagophthalmos were selected who treated with different surgeries during May 2007 to September 2015 in our sanatorium.The surgeries included nylon thread correction surgery, tarsorrhaphy, temporalis transposition surgery.We observed and compared the best corrected visual acuity(BCVA) and the rate of postoperative complications, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus.RESULTS:The effect on BCVA of patients treated with nylon thread correction surgery and tarsorrhaphy:the preoperative and postoperative BCVA was significantly different of the two groups (Z=-4.193,-4.213;P0.05).The postoperative complications:(1) epiphora:there was 91% in patients underwent nylon thread correction surgery, 89% in patients underwent tarsorrhaphy, 59% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=12.198, P<0.05);(2) lacrimal duct injury:there was 66% in patients underwent nylon thread correction surgery, 95% in patients underwent tarsorrhaphy, 41% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=22.415, P<0.05);(3) hard to open eyes:there was 56% in patients underwent nylon thread correction surgery, 55% in patients underwent tarsorrhaphy, 22% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=8.795, P<0.05);(4) infections:there was 84% in patients underwent nylon thread correction surgery, 3% in patients underwent tarsorrhaphy, 11% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=60.858, P<0.05).CONCLUSION:There are certain clinical efficacy for lagophthalmos caused by leprosy after surgery, especially patients after temporalis transposition surgery can close eyes by oneself.And their vision does not change significantly, which suggests that this surgery may prevent exposure injury for cornea.But the iatrogenic injury, the vision decrease in patients underwent other surgeries and the ocular tissue damage, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus should be pay more attention to.

Super-selective renal artery embolization in treatment of iatrogenic renal pseudoaneurysm and arteriovenous fistula / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of super-selective renal artery embolization in treatment of iatrogenie renal pseudoaneurysm and arteriovenous fistula.Methods Twenty-nine patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula underwent renal angiography after ineffective conservative treatment.After identifying the location and characteristic of lesions by DSA,super-selective renal artery embolization was performed.Symptoms and signs,renal function changes before and after embolization and complications were recorded to evaluate the therapeutic effect.Results The technical success rate of super-selective renal artery embolization was 100％ (29/29),and clinical success rate was 96.55 ％ (28/29).The serum creatinine level before and after embolotherapy was (93.26 ± 28.79) mmol/L and (91.51 ± 27.68) mmol/L respectively,and there were no significant differences (t=1.28,P=0.22).No serious complications such as nephrapostasis or renal failure occurred in the study.Conclusion Super-selective renal artery embolization has technically and clinically high success rate with limited effect on renal function.It is a safe and effective therapy method in patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula.

Principles and strategies for the prevention and treatment of parathyroid and larynge-al nerve injuries during thyroid surgery / 中国肿瘤临床

Surgery is the major treatment option for malignant tumors and some benign neoplasms of the thyroid, most of which are differentiated thyroid carcinoma. Despite the progresses that have been made in surgical techniques, iatrogenic injuries of the parathy-roid and laryngeal nerves, including superior and recurrent laryngeal nerves, could not be completely avoided in the surgical manage-ment of thyroid tumors. In this review, the causes of intraoperative injuries of parathyroid and laryngeal nerves are systematically ana-lyzed with respect to types and extents of surgical operations, changes in topical anatomy, and secondary thyroid surgeries. The princi-ples and strategies for protecting and restoring injuries of the parathyroid and laryngeal nerves are also elucidated for the effective prevention and adequate treatment of these major complications in the thyroid surgery.

Prevention and treatment of vascular complications of inguinal hernia repair / 中华消化外科杂志

Objective To explore the prevention and treatment of complications of vascular injury after inguinal hernia repair.Methods The retrospective cross-sectional and descriptive study was adopted.The clinical data of 22 patients with vascular injury after inguinal hernia repair who were admitted to the First Affiliated Hospital of Chongqing Medical University between June 2005 and March 2016 were collected.Observation indicators included:(1) the vascular complications after inguinal hernia repair:vascular injury,peritoneal interstitial hemorrhage or hematoma formation,thrombosis and vascular embolization,(2) treatment,(3) follow-up.Patients were followed up by telephone interview at 15 days after discharge up to April 2016,and conditions of patients,recovery of symptoms and subsequent pharmacotherapy were detected.Results (1) The vascular complications after inguinal hernia repair:of 22 patients,peritoneal interstitial hemorrhage or hematoma formation was detected in 8 patients (vascular injury of corona mortis in 2 patients,inferior epigastric artery injury in 3 patients and unexplained peritoneal interstitial hemorrhage in 3 patients),femoral vein injury in 3 patients,femoral artery injury in 1 patient,deep vein thrombosis of the double lower limbs in 8 patients (including 2 with pulmonary embolism) and femoral and popliteal artery embolism in 2 patients.(2) Treatments:20 of 22 patients had good therapeutic effect,1 patient with arterial embolism received timely treatment avoiding the necrosis of limbs,1 ischemic necrosis of partial toes and the other patients had good effect through vascular repair or construction.One patient with inferior epigastric artery injury and 1 with femoral vein injury died of hemorrhagic shock.(3) Follow-up:20 of 22 patients were followed up for 2 weeks,with good conditions.Patients' hemorrhage had been improved.The symptoms of patients with deep vein thrombosis and arterial embolism of lower limbs didn't become obviously aggravated,and they took the medicine as medical advice.Conclusion The different treatments are conducted according to the occuring characteristics of vascular complications,with better outcomes.

Surgical treatment of azoospermia caused by iatrogenic injury to bilateral vas deferens / 中华男科学杂志

<p><b>Objective</b>To investigate the treatment of azoospermia induced by iatrogenic injury to the bilateral vas deferens.</p><p><b>METHODS</b>We retrospectively analyzed 11 cases of azoospermia caused by iatrogenic injury to bilateral vas deferens. The patients were aged 20－33 years, all diagnosed with azoospermia preoperatively and none with a history of pelvic operation. Seven of them had received bilateral inguinal hernia repair and the other 4 undergone bilateral orchidopexy in the childhood.</p><p><b>RESULTS</b>Intraoperative exploration of the bilateral inguinal region was performed in all the patients. Bilateral vas deference atresia was found in the inguinal canal in 6 cases, which was treated by microscopic vasovasostomy following removal of the atresic segment. Vas deferens residual was observed in or near the deep inguinal ring in the other 5 cases, with the distal vas deferens inaccessible, which was treated by bilateral vasovasostomy in 3 cases and unilateral vasovasostomy in 2 (for longer defect segment than could be anastomosed) following combined laparoscopic exploration of the abdominal cavity. The patients were followed up for 3－12 months postoperatively, during which sperm were detected in 7 cases, with sperm concentration ranging from 0.4×10⁶/ml to 35×10⁶/ml and grade a+b sperm from 15% to 46%.</p><p><b>CONCLUSIONS</b>For the diagnosis of azoospermia, especially in patients with no history of pelvic operation, special attention should be paid to iatrogenic injury to the vas deferens. For the treatment of the disease, non-tension vasovasostomy is essential and, when necessary, the vas deferens can be reconstructed by changing its anatomical path and shortening its length.</p>

Lesión iatrogénica de la arteria iliaca común izquierda durante discectomía lumbar posterior / Iatrogenic injury to the left common iliac artery for posterior lumbar discectomy

Las lesiones vasculares durante la cirugía de hernia discal son infrecuentes, pero asociadas con una alta mortalidad dependiendo del vaso afectado, requiriendo de una sospecha diagnóstica y manejo temprano que puedan evitar el desenlace mortal. Dependiendo del nivel intervertebral intervenido las lesiones vasculares comprometerán en mayor o menor frecuencia los diferentes grandes vasos, siendo más frecuentes los traumas a la aorta en niveles altos y el compromiso de los vasos arteriales y venosos ilíacos comunes o sus ramificaciones en niveles inferiores, las estadísticas en cuanto a incidencia se creen son subestimadas debido a la infrecuencia con que son reportados estos casos. El objetivo de este artículo es exponer el caso de una lesión traumática intraoperatoria de la arteria ilíaca común izquierda durante un procedimiento de hemilaminectomia y microdisectomia L5 - S1, en la que la temprana sospecha de la lesión y contar con equipo quirúrgico altamente capacitado en la institución permitió realizar un manejo oportuno sin secuelas neurológicas o vasculares para el paciente. Compartimos este caso dado lo infrecuente de sus reportes en la literatura revisada, si tenemos en cuenta la frecuencia con el que neurocirujano o cirujano de columna realiza procedimientos para corrección de hernias discales, sin dimensionar en muchas ocasiones el alto riesgo de morbi-mortalidad derivadas de una complicación quirúrgica, que en nuestro caso de no haber contado con el equipo quirúrgico idóneo (anestesia, cuidados posoperatorios, cirujanos generales y vasculares), no se hubiera obtenido el buen resultado para el paciente.

Vascular injury during surgery herniated disc are rare, but associated with high mortality depending on the affected vessel, requiring a diagnostic suspicion and early management to avoid a fatal deselance. Depending on the level involved surgical, vascular lesions are more commonly involved trauma of the aorta at high levels and commitment of arterial and venous vessels common iliac, less frequently commits its branches at lower levels. Due to the low incidence of reporting of these cases statistics are underestimated. The aim of this article is to present the case of a traumatic injury intraoperative left common iliac artery for a microdiscectomy procedure hemilaminectomy and L5 - S1, where a timely management was conducted through early suspicion of injury and the surgical team highly trained in the institution. There were no neurological or vascular consequences for the patient. We share this case due to the rareness of their reports in the literature reviewed, if we consider the frequency with which neurosurgeon or spine surgeon performs procedures to correct herniated discs, not to mention the high risk of surgical morbidity and mortality. In our case you have not had the ideal surgical equipment (anesthesia, postoperative care, general and vascular surgeons) had not obtained the good result for the patient.

New Classification of Bile Duct Injuries Based on Clinical Scenarios.

A new classification of the iatrogenic bile duct injuries based on clinical scenario is presented. It is actually clinical scenario which determines the type and time of intervention required. From the initial classification published by Bismuth, there have been many classifications of common bile duct injury. The article reviews the various classification systems.

Aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares / Epidemiological aspects of patients with iatrogenic biliary

Objetivo: avaliar os aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares no Serviçode Cirurgia Geral e do Aparelho Digestivo do Hospital Universitário João de Barros Barreto nos últimos 10 anos.Método: estudo transversal e retrospectivo dos prontuários de 25 pacientes com diagnóstico de lesão iatrogênica davia biliar. Foram incluídos pacientes oriundos do próprio serviço e de outras instituições. O período foi de janeirode 1999 a dezembro de 2008. Resultados: foram encontrados 25 casos de lesões iatrogênicas das vias biliares,sendo 22 consequentes de colecistectomias convencionais. Um total de 56% foi procedente de outras instituições. Asmanifestações clínicas mais prevalentes: dor abdominal (88%), icterícia (76%) e colúria (56%). O tempo de evoluçãodos sintomas variou desde 1º pós-operatório até 168 meses (14 anos). Cerca de 16% apresentavam diagnóstico decolangite no momento da internação. O método de diagnóstico mais utilizado foi a colangiopancreatografia retrógadaendoscópica (48%), seguida da colangiorressonância (28%). As estenoses classificadas como Bismuth II foramas mais encontradas (40%), seguidas de Bismuth III (32%). A cirurgia corretiva foi a hepático-jejunoanastomoseem Y de Roux (92%). As lesões vasculares foram as principais complicações intra-operatórias. O tempo médiode internação foi de 21dias. Conclusão: a maioria dos casos de iatrogenias foi proveniente de colecistectomiasconvencionais, realizadas em centros não especializados em cirurgia de vias biliares. O respeito ao rigor técnico dacirurgia permanece sendo medida preventiva mais eficaz para a diminuição da incidência de iatrogenias das viasbiliares

Objective: to evaluate the epidemiological aspects of iatrogenic injuries of bile ducts of patients seen in generalsurgery service and the digestive system of the University Hospital João de Barros Barreto in the last 10 years.Method: we performed an observational study, the type of retrospective medical records of patients with iatrogenicinjury of the biliary tract. We included patients from the service itself and other institutions. The variables studiedwere sex, age, origin, clinical manifestations, presence of cholangitis, time course, diagnostic method used, surgerythat caused the injury, surgery for the correction, the second Bismuth classification of the lesion, intraoperativecomplications surgery and hospital stay. Results: we found 25 cases of iatrogenic biliary tract, with 22 resulting fromconventional cholecystectomy. A total of 56% came other institutions. The female sex was more prevalent (80%), theaverage age of patients was 43 years. The most prevalent clinical manifestations: abdominal pain (88%), jaundice(76%) and dark urine (56%). The duration of symptoms ranged from 1 postoperative day up to 168 months (14years). About 16% had a diagnosis of cholangitis at admission. The method most frequently used is the endoscopicretrograde cholangiopancreatography (48%), followed by magnetic resonance cholangiography (28%). The stenosesclassified as Bismuth II were the most frequent (40%), followed by Bismuth III (32%). Corrective surgery washepatic-jejunoanastomose Roux-Y (92%). Vascular lesions were the major intraoperative complications. The meanhospital stay was 21 days. Conclusion: most cases of iatrogenic injuries came from conventional cholecystectomyperformed in centers not specialized in surgery of the biliary tract. Respect for the technical accuracy of the surgeryremains the most effective preventive measure for reducing the incidence of iatrogenic injuries of bile ducts.

Experience in the treatment of perforating injury of the distal common bile duct during biliary exploration / 中华肝胆外科杂志

Objective To study the results using T-tube and retroperitoneal space drainage to manage perforating injury of the distal common bile duct(PIDC) during common bile duct(CBD) exploration.Methods We retrospectively analyzed the clinical data of 12 patients who were diagnosed to suffer from PIDC during CBD exploration from 2010 to 2012.Result All these 12 patients who received T-tube and retroperitoneal space drainage,gastrointestinal decompression,nutritional support and antibiotics recovered uneventfully.Conclusion Given that the CBD was unobstructed,T-tube and retroperitoneal space drainage was an good treatment for patients with PIDC.

Obstructive azoospermia: reconstructive techniques and results

Obstructive azoospermia is a common cause of male infertility and can result from infection, congenital anomalies, or iatrogenic injury. Microsurgical vasal reconstruction is a suitable treatment for many cases of obstructive azoospermia, although some couples will require sperm retrieval paired with in-vitro fertilization. The various causes of obstructive azoospermia and recommended treatments will be examined. Microsurgical vasovasostomy and vasoepididymostomy will be discussed in detail. The postoperative patency and pregnancy rates for surgical reconstruction of obstructive azoospermia and the impact of etiology, obstructive interval, sperm granuloma, age, and previous reconstruction on patency and pregnancy will be reviewed.

Lesiones quirúrgicas de la vía biliar / Surgical bile duct injuries

RESUMEN Introducción: las lesiones iatrogénicas de la vía biliar son situaciones clínicas complejas, producidas generalmente por los cirujanos en pacientes habitualmente sanos, asociadas a una morbilidad importante y una mortalidad baja pero no despreciable. Objetivo: describir las características clínicas asociadas a la lesión quirúrgica de vía biliar. Materiales y Métodos: estudio descriptivo y retrospectivo sobre una serie de 8 pacientes tratados por lesión quirúrgica de la vía biliar en el Servicio de Cirugía General del Hospital Nacional (Itauguá) mediante la revisión de fichas clínicas en un periodo comprendido entre enero de 2007 a enero 2012. Resultados: se recolectaron 10 pacientes con lesión de la vía biliar, 8 mujeres (80%), con una edad media 43 años (rango de 16-72 años). La cirugía inicial de todos los pacientes fue la colecistectomía, en 4 pacientes (40%) fue una cirugía de urgencia por una colecistitis aguda y 6 pacientes (60%) una cirugía electiva por una colecistopatía crónica calculosa. En 9 casos la lesión se produjo en una cirugía convencional por la vía abierta y en 1 paciente fue en el trascurso de una colecistectomía por videolaparoscopía. Conclusión: la lesión de la vía biliar fue iatrogénica y se asoció a colecistectomía electiva por colecistopatía crónica calculosa realizada por cirugía convencional por la vía abierta.

ABSTRACT Introduction: iatrogenic lesions of the biliary duct are complex clinical situations, generally produced by surgeons in usually healthy patients associated with significant morbidity and low, but not negligible mortality. Objective: To describe the clinical characteristics associated with surgical bile duct injury. Materials and Methods: descriptive, retrospective study on a series of 8 patients treated for surgical injury of the bile duct at the General Surgery Service of the National Hospital (Itauguá) by reviewing medical records in a period from January 2007 to January 2012. Results: 10 patients with bile duct injury were gathered, 8 women (80%), mean age 43 years (range 16-72 years). Initial surgery for all patients was cholecystectomy, in 4 patients (40%) emergency surgery for acute cholecystitis was performed and in 6 patients (60%) elective surgery for a chronic calculous gallbladder disease. In 9 cases the injury occurred in conventional open surgery and 1 patient was during the course of a video laparoscopy cholecystectomy. Conclusion: The bile duct injury was iatrogenic and associated to elective cholecystectomy for chronic calculous gallbladder disease performed by conventional open surgery.

Lesiones de la vía biliar: Prevalencia en pacientes con colecistectomía laparoscópica en un hospital de especialidades / Bile duct injuries: prevalence in patients subjected to laparoscopic cholecystectomy in a Specialties Hospital

Objetivo: Conocer la prevalencia de lesión de la vía biliar por colecistectomía laparoscópica y compararla con la prevalencia internacional de 0.4% a 0.6%. Sede: Hospital de Especialidades de la Ciudad de México ''Dr. Belisario Domínguez''. Diseño: Retrospectivo, transversal, observacional y descriptivo. Estadística: Porcentajes como medida de resumen para variables cualitativas Material y métodos: Se realizó un estudio de los expedientes de pacientes operados de colecistectomía laparoscópica durante los años 2005 a 2008 por el Servicio de Cirugía General. Las variables a estudiar fueron prevalencia de lesión de la vía biliar clasificándola de acuerdo a las escalas de Strasberg, edad y género. Resultados: Durante 4 años se realizaron 532 colecistectomías laparoscópicas a pacientes de sendos géneros de 15 a 89 años de edad, identificándose 3 pacientes con lesión de la vía biliar (0.56%). En dos, la lesión consistió en sección total del conducto colédoco y en el tercero hubo fuga de bilis por el muñón del conducto cístico. La reparación consistió en colédoco-colédoco anastomosis término terminal con colocación de sonda en T en dos casos y en ligadura del muñón del conducto cístico en el tercero. Uno (33.3%) de los 3 pacientes falleció, 2 (66.6%) presentaron complicaciones posteriores a la reparación de la vía biliar. Conclusiones: La frecuencia de lesión de la vía biliar en pacientes colecistectomizados laparoscópicamente en el Hospital de Especialidades ''Dr. Belisario Domínguez'' fue de 0.56%; es similar a la reportada en la literatura.

Objective: To know the prevalence of injury to the bile duct by laparoscopic cholecystectomy and to compare this with the international prevalence of 0.4% to 0.6%. Setting: Specialties Hospital of Mexico City ''Dr. Belisario Domínguez''. Design: Retrospective, transversal, observational, and descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: We studied the clinical records of the patients subjected to laparoscopic cholecystectomy from 2005 to 2008 at the General Surgery Service. Results: During the four years, 532 laparoscopic cholecystectomies were performed in patients of either gender, aged from 15 to 89 years. We identified three patients with bile duct injury (0.56%). In two, the injury consisted of a complete section of the choledocus and the third patient presented cystic conduct stump bile leak. Repair consisted of termino-terminal choledocus-choledocus anastomosis with placement of a catheter in T, and ligature of the cystic conduct stump in the third patient. One (33.3%) of the three patients died, two (66%) presented complications after bile duct repair. Conclusions: Frequency of injury to the bile duct in patients during laparoscopic cholecystectomy at the Specialties Hospital ''Dr. Belisario Domínguez'' was of 0.56%, which is similar to that reported in the literature.

Advances in researches on biodegradable materials for bile duct repair / 中华肝胆外科杂志

To sacrifice the function of the sphincter of Oddi in the routine management of iatrogenic biliary injury,e.g. by using cholangio-enterostomies, is often complicated by ascending biliary infection, cholangitis and an increased risk of cholangiocarcinoma. It is necessary to find a material which can protect the bile duct. As reported, biodegradable materials which are hopeful to be used clinically have the advantages of being non-immunogenic, gives temporary supportive function, and produces harmless degradation products. This article aims to review the advances in researches on biodegradable materials for bile duct repair.

Pathophysiological changes and operative timing of iatrogentic biliary tract injury / 中华肝胆外科杂志

Long-term outcomes of surgical bile duct injury (BDI) repair are affected by multiple factors, such as surgeon's experience, severity of BDI, pathological changes of the proximal duct, and the manner and timing of surgical repair. However, the timing of BDI repair is still controversial still. In this article, the authors reviewed the correlation of pathophysiologic changes of the proximal duct, repair timing and outcome discussed in English references. It was shown that pathophysiologic changes of the proximal duct are a major contributor to the timing of BDI repair.

Hospital Infection in Iatrogenic Injury:An Epidemiological Analysis / 中华医院感染学杂志

OBJECTIVE To explore the features,developing trend and factors of hospital infection in patients with iatrogenic injury.METHODS Retrospective surveys of hospital infections in 750 cases with iatrogenic injury were carried out in hospital between 2000 and 2007.RESULTS The incidence of hospital infection in patients with iatrogenic injury was 87.39%.Among them,hospital wound infection was the highest(87.39%),the second one was cavity infection(8.98%).The leading causative microorganisms were Gram-negative bacteria.CONCLUSIONS It is imperative to make effort to decvease the morbidity of hospital infections.We hope that the iatrogenic injury can be brought into the category of public health as soon as possible to enhance the medical care service and secure safty and health of the patients.