Discussion Of Iatrogenic Bile Duct Injury

Subject: (1) To investigate the causes, prevention and treatment of iatrogenic bile duct injury. (2) The incidence change of iatrogenic bile duct injury for the last 20 years. (3) The methods for reducing the cases of LC learning curve. (4) The causes and prevention of bile leakage after removed T-tube.Methods: (1) The clinical data of patients with iatrogenic bile duct injury treated in the second hospital of Tianjin medical university and Jixian people hospital were retrospectively analyzed from 1984 to 2004,according to the common factors of iatrogenic bile duct injury and the respective reason of bile duct injury in different operation manners. (2) Patients were divided into two groups according to operation time:① 1984-1994;② 1994-2004. And then the incidence of iatrogenic bile duct injury were investigated.(3) clinical data of 413 patients with laparoscope cholecystectomy(LC) were summarized .(4) 10 patients with bile leakage after removed T-tube were retrospectively analyzed.Results: (1) 4354 Extrahepatic bile duct operated in two hospitals from 1984 to 2004. 16 cases of iatrogenic bile duct injury occurred (7 cases happened in the second hospital of Tianjin medical universityand 3 in Jixian people hospital ). 10 in cholecystectomy, 4 in choledochal exploration, 1 in gastrectomy ,1 uncertain (possible for bile duct ischemia).All patient were operatively treated. Of the 16 patients,8 cured,4 mended, 1 unchangeable,! died,2 not followed up. (2) The first group (2018 patients): 10 cases of iatrogenic bile duct injury occurred (4 in the Second Hospital of Tianjin medical university , 3 in Jixian people hospital). 4 cured,3 mended, 1 unchangeable,! died,l not followed up. The second group (2346 patients): 6 cases of iatrogenic bile duct injury occurred (2 in the Second Hospital of Tianjin medical university, 1 in Jixian people hospital). 4 cured,3 mended, 1 not followed up. The percentages of iatrogenic bile duct injury were 0.35% and 0.13% respectively. (3) 1 case occurred complication in 413 cases with LC. (4) the mean time of removed T-tube in patients with bile leakage were 28.7 ± 7.3 days, the mean serum albumin level were 33.4±2.5 g/L, the mean hemoglobin level 116.5+17.3 g/L; while the mean time of removed T-tube in patients without bile leakage were 24.3±6.5days, the mean serum albumin level were 37.9+1.7 g/L, the mean hemoglobin level 143.4 + 12.7 g/L.Conclusions: (1) Cholecystectomy is the main reason of iatrogenic bile duct injury.(2) the incidence of iatrogenic bile duct injury...