Analysis For 17 Clinical Cases Of Bile Duct Injury Induced By Laparoscopic Cholecystectomy

Backgrounds As is known to all,cholelithiasis is the common disease in China.With people's higher and higher requirement for living quality and the gradual maturity and popularity in endoscopic minimally invasive techniques,the laparoscopy cholecystectomy(simplified as LC)has been universally acknowledged as the primary operation method for treating the gall bladder-related benign disease.Not only has the bile duct injury accounted for a large proportion of the LC-related complications but it has also become one of the primary reasons for many medical disputes in general surgery department.In this research,4287 patients who ever had the LC operations in Shangqiu's first People Hospital are reviewed retrospectively.Through the analysis of the factors which may cause the bile duct's injury,this research mainly probes into the prevention and the corresponding treatment measures of the bile duct injury.Besides,it also provides some references for the clinical work.Objective Through analysis and summary of the general information related to recent 8 year's LC cases' in Shangqiu's first People's Hospital,this research analyzes the factors of the bile duct injury induced by LC,and well defines the reasons of bile duct injury to direct surgical operators to decrease the occurrence rate of bile duct injures.Meanwhile,this research explores the prevention methods and treatment measures of the bile duct injury.Methods From June in 2008 to October in 2016,4287 patients from general surgery department of the Shangqiu's first People Hospital who ever had the indications of LC and have already had the operations of the LC have been selected,among whom 17 patients who had the bile duct injury would form the observatory group,and 51 patients would be selected randomly from the rest 4270 patients who never had the bile duct injury complications to constitute the control group.By employing the retrospective study mode,we choose 7 factors of the bile duct injury induced by the LC as the observational indexes: gender,age,gallbladder wall thickness,gallbladder inflammation stage,the doctor's surgical experience,preoperative liver function,bile duct anatomic variation.According to the 7 indexes and the comparative analysis of the single factors of t test and ?2 test,factors of the bile duct injury caused by LC and with the statistical significance would be screened out by statistical methods.After that,we would make the logistic regression analysis of these factors to get the risk factors of the bile duct injury induced by LC.Meanwhile,we analyze and sum up the tendency in occurrence rate of the bile duct injury in LC within recent 8 years and the treatment measures for patients who had the bile duct injury.Results 1.The occurrence rate of the bile duct injury in Shangqiu's first People Hospital has gradually declined within recent 8 years.And the possible reasons maybe as follows: a.the improvement of surgical doctors' operational experience;b.the annual increase in the number of the LC surgery;c.surgeons' more attention to LC operation timing and the improvement in the cognition of the bile duct's anatomic variation.2.Through the single factor analysis of the possible index which may lead to the bile duct's injury during the LC operations,statistical difference(p< 0.05)can be found among four indexes that respectively are acute inflammation,gallbladder's incrassation of more than 3 mm,anatomic variation in biliary tract,operator's less surgical experience,all of which are regarded as the risk factors that lead to the bile duct injury.The unconditionally multivariable logistic analysis of regression shows that the bile duct anatomic variation and the operator's less surgical experience belong to the high risk factors of bile duct injury induced by LC.3.2 patients with common bile duct injury underwent cholangiojejunostomy with Rouxen-Y anastomosis,2 cases of cystic duct stump leakage in patients with cystic duct ligation,right hepatic duct repair in 3 patients,bile duct ligation in 8 patients,T tube support for total hepatic duct repair in 1 patients,1 cases of hepatic duct injury underwent primary choledochal anastomosis plus left lateral lobe resection plus left hepatic duct jejunostomy.Patients were followed up without recurrent cholangitis and bile duct strictures,such as abnormal liver function,recurrent biliary tract calculi,colorectal cancer,liver atrophy and other related diseases.Conclusion 1.There are many reasons leading to the bile duct's injury in LC,which include the surgeon's lack of rich operational experience,the pathological or the physiological anatomy variation of the biliary tract,the acute phase of the gallbladder inflammation,the obvious incrassation of the gallbladder wall and so on.Therefore,the surgeon are supposed to be equipped with a wealth of operational experience,proficient operation techniques,professionally anatomic knowledge of the biliary tract and the accurate grasp of the operation timing.Only in this way can the occurrence rate of the bile duct injury induced by LC decline as far as possible.2.The ideal way of repairing is to discover the injury timely during the LC and invite the experienced specialist to make the 1st stage repair.Early prevention,early detection and early rational treatment are very important for the prognosis of patients.