Discussion On Surgical Repair Of Iatrogenic Bile Duct Injury

Objective:To explore the choice of surgical methods in the surgical repair of iatrogenic bile duct injury.Methods:By reviewing the relevant literatures in the past 20 years,we analyzed the causes,types,clinical manifestations,treatment methods and postoperative efficacy of iatrogenic bile duct injury.We try to explored how to choose a reasonable surgical approach when bile duct injury occurred.Results:Type Ⅰ,type Ⅱ1,type Ⅱ2,type Ⅱ3 bile duct injury can be repaired by simple suture repair,replacement,bravery intestinal anastomosis,liver resection achieve ideal treatment effect,Type Ⅱ4 damage occurs,the affected area should be based on the liver reserve capacity,as the case for bile duct reconstruction or liver resection,Type Ⅲ injury preferred endoscopic stenting and percutaneous puncture drainage,liver transplantation is biliary injury lead to end-stage liver disease is the only effective treatment.Conclusion:The principle of treatment of IBDI is to reconstruct the continuity of the bile duct by repairing,matching,etc.,and to reduce the probability of recurrence of postoperative stenosis while solving bile duct defects and stenosis.Type I,type Ⅱ1,type Ⅱ2,and type Ⅱ3 involve biliary ducts in the pancreaticoduodenal region,extrahepatic bile ducts,and primary bile ducts.For these typies of bile duct,repair and reconstruction should be preferred in principle,and some lesions are neatly cut.If the bile duct is well-transported and the longitudinal length is less than 1cm,the suture can be repaired by simple suture.The suture should be selected to absorb the suture,avoiding the proliferation of the tissue after suture stimulation,leading to postoperative bile duct stricture.If the defect area is large and the repair is difficult,the replacement tissue can be used for repair.In the alternative tissue selection,the gallbladder neck wall and the jejunal wall are generally preferred;when the bile duct transverse injury and the bile duct defect are difficult to repair,the bile duct end-to-end anastomosis Should be considered as the first surgical method,when the distance between the ends is large or the type Ⅱ2 injury of the confluence of the left and right hepatic ducts,the cholangioenterostomy should be selected.When the biliary anastomosis is performed,the proximal end should be treated as appropriate.The bile duct is shaped to ensure the best fit.The bile duct-jejunum Roux-en-y anastomosis should be the first choice during the biliary anastomosis.When the right hepatic artery is combined with injury,in addition to repairing and reconstructing the damaged bile duct,the damaged right hepatic artery should be repaired and reconstructed to ensure the right half liver blood supply.In the case of damaged right hepatic artery and difficulty in repair and reconstruction,right hepatectomy should be performed to prevent hepatic necrosis while the damaged bile duct is repaired and reconstructed.When type Ⅱ4 injury occurs,it is very difficult to repair and reconstruct the damaged bile duct.The liver function assessment of the unaffected area should be performed.Under the condition of ideal liver function compensation,the damaged bile duct or the affected liver segment can be ligated.When the liver function is insufficient,it is still necessary to achieve reconstruction through hepatic duct jejunostomy.The treatment of type Ⅲ injury is generally selected by endoscopic stent placement or percutaneous puncture drainage.Surgical repair and reconstruction are not considered in this situation.Liver transplantation should be performed when the bile duct injury undergoes multiple operations and the treatment effect is not satisfactory secondary to liver failure.