| Objective1. To review the iatrogenic biliary injuries cases by surgical treatment retrospectively and To analyze the pathogeny, causes of failure in the early and late surgical treatment of biliary injuries and strictures , to summarize the experiences in surgical management of biliary strictures and to discuss principle of the diagnosis, surgical technique and surgical treatment of iatrogenic biliary injuries for improving the level of the surgical treatment. 2. To assess the efficacy, safety and feasibility of a new biodegradable poly-1-lactic acid stent in repair of bile duct injury. Materials and Methods1. 159 patients with iatrogenic biliary injuries and strictures between Jan. 1989 and Oct.2002 were reviewed retrospectively. Of them 82 cases were early treated in other hospitals (74 cases) and in our department (8 cases). In which, 46 cases were detected in operation and repaired simultaneously, the repair styles included choledochojejunostomy with Roux-en-Y loop and anastomosis of end to end of bile duct. 36 cases were detected postoperatively and treate, the operation styles included celiac drain andcholedochojejunostomy with Roux-en-Y . 159 cases with late biliary stricture were repaired operatively in our department, in which, 142cases underwent hepaticojejunostomy with Roux-en-Y , 14 cases were repaired by pedicle flap of autogenous tissues. A cases with biliary cirrhosis and sclerotic cholangitis underwent the liver transplantation.2. The PLLA material with molecular weight( 100000) was hot-pressed into board that was cut out into strip, then the strip was wrapped around the columned pattern and was heated to 50℃ with heat-preserved for 10 hours into twist stent.after anaesthetization , four dogs(male two and female two, age from one to two years,, bodyweight from 14.5 to 18Kg, average 16.8Kg ) were operated on cholecystectomy and cholangiography was done. Then, common bile duct was traversed for the model of bile duct injury. Duct to duct anastomosis was done by 5-0 absorbable suture with stenting of the biodegradable poly-1-lactic Acid stent. Cholangiography was performed in 10, 11, 13 and 15 weeks postoperatively, and at the same time, tissues of the liver and common bile duct were taken for histological evaluation by paraffin with H-E stain.The stent material that was immerge in bile for 14 days was investigated by SEM and tested for DSC.The different kinds of materials that were immerged in bile for 28 days were investigated by SEM at 0, 7, 14 and 28days. Results1. Cholecystectomy including Laparoscopic Cholecystectomy was the main cause resulting in the bile duct injure. The results of75/82 cases that were treated early by surgery were poor and need reoperation. The main causes of failure were biliary fistula and removing the biliary stents too early. The results of 159 cases with late biliary stricture were repaired operatively were good with 90 % efficacy. Recurrence of the biliary stricture was 10%. A case with severe biliary cirrhosis of liver and portal hypertension died postoperatively.2. Serum bilirubin levels remained within the normal range in all dogs throughout the study period. Cholangiography demonstrated that the stents were patent and no biliary stricture. The stents were expanded in the bile duct without migration and without biliary sludge accumulation. Histological evaluation revealed normal bile duct epithelium with no stent-induced inflammation and epithelial hyperplasia. The scan electron microscope demonstrated that there was no biliary sludge in the stents three months after placement. In vitro, the stent had been degrading fourteen days later. Follow the time, there were thin granules on the surface of all materials, less and thin in U or T type tube. At 14 days, the number of the granules on the surface of PLA was the most, but decreased at one month. Conclusions1. The main causes of failure were biliary fistula and removing the biliary stents too early. The hepaticojejunostomy with Roux-en-Y loop is a effective method to treat the biliary stri... |
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