Clinical experience on 5 patients with delayed complications after iatrogenic bile duct injuries / 中华肝胆外科杂志

ABSTRACT

Objective To evaluate the therapeutic methods and the key points in the management of delayed complications of bile duct stenosis after iatrogenic bile duct injuries.Methods Five patients with bile duct injuries developed delayed complications of bile duct stenosis after cholecystectomy were retrospectively studied.All clinical information were derived from the medical data of these 5 patients treated in our department from June 2002 to July 2006.Results Of the 5 patients with delayed complications of iatrogenic bile duct injuries,2 patients developed common bile duct occlusion,2 patients developed hilar bile duct stenosis,and 1 patient developed anastomotic stenosis after cholangiojejunostomy.Bile duct injuries occurred in 3 patients after laparoscopic cholecystectomy,and in another 2 patients after mini-laparotomy-cholecystectomy.The locations of the bile duct injuries,according to Strasberg classification,were type E1 (n=1),type E2 (n=1),type E3,(n=1),and type E5 (n=2).All 5 patients received PTCD initially to relieve obstructive jaundice and then they received surgical exploration and biliary reconstruction.These patients received cholangioplasty at the porta hepatis,and hepaticojejunostomy using a Roux-en-Y anastomosis.Two patients received Roux-en-Y anastomosis of the common hepatic duct to the jejunum.All these patients had good recovery and were discharged well postoperatively.All patients had been followed-up for 7 years or more,with no evidence of obstructive jaundice or biliary tract infection.Conclusions For patients who present with delayed complications of bile duct stenosis after iatrogenic bile duct injuries,primary PTCD is carried out to relieve jaundice and to control infection.Meticulous dissection of the porta hepatis,reliable anastomosis of the proximal healthy bile duct tissues to a jejunal loop,and adequate size of anastomosis guarantee success of surgery.