Lesiones iatrogénicas de la vía biliar principal, manejo terapéutico. Reporte de 5 casos representativos y revisión de la literatura / Iatrogenic injuries of the common bile duct and therapeutic management. Report of 5 representative cases and review of the literature

Objetivo: Revisar el manejo terapéutico, según el tipo de lesiones, ubicación de acuerdo a la clasificación de Strasberg's ­ Bismuth, y según el momento en que se realiza el diagnóstico. Métodos: Se presentan 5 casos con lesiones iatrogénicas de la vía biliar, en un total de 411 colecistectomías en el Hospital José María Benítez, desde enero 2008 a octubre 2013, en las cuales se realizó tratamiento quirúrgico y/o endoscópico según el caso. Estudio descriptivo y retrospectivo. Resultados: De los 5 pacientes, presentados 4 pertenecen al Hospital José María Benítez y uno fue referido de otro centro asistencial, total de 411 colecistectomías, abiertas 310, laparoscópicas 101. La incidencia en colecistectomía abierta 0,97% (3/309) y en colecistectomía por laparoscopia 0,99% (1/101). La resolución se realizó en 4 casos con tratamiento quirúrgico y en 1 caso con tratamiento endoscópico, esfinterotomía más stent biliar. Evolución post-operatoria sin complicaciones. Conclusión: Las lesiones iatrogénicas de la vía biliar principal son situaciones clínicas complejas con importante morbilidad,generando complicaciones agudas o crónicas afectando severa-mente la calidad de vida en el mejor de los casos, en su gran mayoría se producen durante colecistectomías y se considera que son el resultado de una identificación incorrecta de los elementos del triángulo de Calot. Una vez que se presentan se requiere de un abordaje integral y de un equipo entrenado multidisciplinario entre cirujanos, radiólogos, y endoscopistas(AU)

Objective: To review the therapeutic, depending on the typeof injury management, location according to the classification of Strasberg's - Bismuth, and according to the moment in which the diagnosis is made. Methods: Five cases with iatrogenic injuries of the biliary tract, of 411 cholecystectomies in the Hospital José María Benítez since January 2008 to October 2013, which was carried out surgical or endoscopic treatment according to the case are presented. It's a descriptive and retrospective study.Results: Of the 5 patients presented, 4 belong to the Hospital José María Benítez and one was referred to other healthcare, total 411 cholecystectomies: open 310, laparoscopic 101. The incidence in open cholecystectomy 0.97% (3/309) and laparoscopic 0.99% (1/101). The resolution was carried out in 4 cases with surgical treatment and in 1 case with endoscopic treatment, sphincterotomy plus biliary stent. Postoperative evolution was without complications. Conclusion: The main bile duct iatrogenic injuries are complex clinical situations with significant morbidity, generating acute or chronic complications, severely affecting the quality of life in the best of cases, the vast majority occur during cholecystectomies andit is considered to be the result of an incorrect identification of the elements of Calot's triangle. Once presented, requires a comprehensive approach and a trained multidisciplinary team between surgeons, radiologists, and endoscopists(AU)

Clinical treatment of iatrogenic peripheral nerve injury / 中华创伤杂志

ObjectiveTo retrospectively analyze the clinical outcome of patients with iatrogenic peripheral nerve injury so as to summarize the experiences and lessons.MethodsA retrospective study was performed on 72 patients with iatrogenic peripheral nerve injury treated in our hospital from 2004 to 2010.Therapy methods included conservative treatment in 24 patients,surgical release in 21 and nerve anastomosis in 27.Results All the patients were followed up for average 10 months ( range,3-24months).The neurological recovery was excellent in 24 patients,good in 21,fair in 16 and poor in 11,with excellent rate of 64％,according to the trial standard of upper limb functional assessment established by Chinese Medical Society of Hand Surgery.ConclusionsRisk awareness should be strengthened on the iatrogenic peripheral nerve injury,especially the minimally invasive treatment of fractures in recent years,which has increased the risk of nerve injury.For patients who may be presented with iatrogenic injury,we should develop a detailed preoperative surgical plan for early one stage treatment as possible.

Diagnosis and management of iatrogenic ureteral injury / 中华创伤杂志

Objective To analyze the characteristics of iatrogenic urerteral injury and summarize the experiences in prevention,diagnosis and treatment of iatrogenic urerteral injury. MethodsA review was made on the injurycauses,the injury locations,the treatment time,the methods of surgical procedures and the results of treatment in 17 patients with iatrogenic ureteral injury treated surgically from 1997 to 2003. Results Of 17 cases of iatrogenic ureteral injuries,gynecological,general surgical and urological procedures resulted in ureteral injuries in 12 cases (71%),four (24%) and one (6%),respectively. Of all the injuries,65% (11/17) appeared in the lower part of the ureter,18% (3/17) in the middle part of the ureter and 18% (3/17) in the upper part of the ureter. The main injury causes were ligation,partial ligation,complete transection and perforation,accounting for 29% (5/17),41% (7/17),24% (4/17) and 6% (1/17),respectively. Four cases were found during operation,nine at days 2-11 after operation and four were treated 3-6 months after injury. Treatment methods included end-to-end ureteral anastomosis in seven cases,ureteroneocystostomy in three,ureteral lithotomy in one,pure ureteral lysis in three and post-lysis double-J tube insertion in three. All patients were cured. The follow-up ranging from six months to three years showed no patients suffering from urinary tract infection,hydronephrosis or atrophy. Conclusions The location and type of injury determine the type of surgical repair. A thorough knowledge of pelvic anatomy and mastering the basic steps of diagnosis and treatment are critical for prevention and management of the iatrogenic urerteral injury.