| Purpose:To investigate the prevention and treatment of bile duct injury during laparoscopic cholecystectomy.Methods:By consulting a large amount of literature and related books on the Internet,we collected the general information of 37 patients with LC concurrent BDI diagnosed and treated in the first affiliated hospital of Chengdu Medical College and the second affiliated hospital of Chengdu Medical College from January 2010 to December 2018,and explored the correlation between BDI injury The risk factors were retrospectively analyzed with clinical data such as injury time,injury type,treatment method and prognosis.Results:1.Analysis of the risk factors related to BDI caused by LC.In this study,37 patients with biliary tract injury were selected as the BDI injury group.53 patients with no BDI injury after LC were randomly selected in our hospital as the control group.After univariate analysis,the results showed gender and age was no statistical difference between previous cirrhosis and BDI(P>0.05).Gallbladder disease status(62.2% vs33.9%,P = 0.008),gallbladder wall thickness(75.7% vs 30.2%,P <0.001),anatomical variation(35.1% vs 11.3%,P = 0.006),Mirizzi syndrome(21.6% vs 3.8%,P = 0.008)and operator experience(81.1% vs 32.1%,P <0.001)were statistically significant.After multivariate analysis was included,the results suggested that there was no statistical difference in the degree of gallbladder inflammation.Gallbladder disease status(P =0.120),operator experience(OR = 0.055,P <0.001),combined with Mirizzi syndrome(OR = 11.302,P = 0.02),anatomical variation(OR = 8.477,P = 0.011),gallbladder wall thickness(OR = 11.038,P <0.001)The differences were statistically significant.2.Of the 37 patients in this study,17 were males and 20 were females.The youngest was 35 years old and the oldest was 72 years old,with an average age of 50.5years.Twelve cases were found intraoperatively,of which two cases had gallbladder bed vagal bile duct injury and vagal bile duct ligation;4 cases had bile duct wall injuryand bile duct repair + T tube drainage;3 cases had common bile duct injury and had bile duct end-to-end anastomosis + T tube.Drainage;1 case with bile duct wall injury underwent bile duct jejunum Roux-en-y anastomosis;1 case with right accessory hepatic tube misclamped for right accessory hepatic duct-common hepatic duct anastomosis + T tube drainage;1 case with right accessory hepatic duct Open injury was performed with right parahepatic suture.Twenty-five cases were found postoperatively,of which one case had a stump of the gallbladder duct that underwent open ligation of the stump of the gallbladder duct;one case had a conservative treatment for the leakage of the stump of the gallbladder duct;4 cases had conservative abdominal drainage due to vagal bile duct injury;Biliary duct injury was performed bile duct anastomosis + T-tube drainage;13 cases of common bile duct injury were treated with bile duct jejunum Roux-en-y anastomosis;2 cases of extrahepatic bile duct stricture were treated with intervention.As a result,6 cases of biliary stenosis occurred after operation,1 patient received interventional treatment again,and 5 patients received bile duct jejunum Roux-en-y operation.The patients recovered was satisfactory.Conclusions:1.The acute phase of cholecystitis,the operator's experience,and the combined Mirrizzi syndrome are the relevant factors of BDI caused by LC.Therefore,the operator is required to accurately evaluate before surgery,perform fine operations during the operation,and switch to laparotomy if necessary to effectively prevent BDI.2.MRCP is extremely important for the clinical diagnosis of BDI.It can reveal the complete bile duct tree,which is helpful for the diagnosis and typing of BDI,and provides help for clinical treatment.3.Intraoperative is the best time to treat BDI.In situ bile duct anastomosis(biliary repair,bile duct end-to-end anastomosis)is the most important treatment method for diagnosing BDI during surgery.It requires the surgeon to accurately assess the extent of the injury and strictly grasp the indications for surgery,which can achieve better results.4.Roux-en-y surgery is widely used in clinical practice.It is a relatively sure operation for BDI,but it also needs sufficient surgical skills and surgical experience to effectively avoid the re-stenosis of the anastomosis.5.The curative effect of interventional therapy for BDI is not clear at present,but in some critical patients who cannot tolerate surgery,it can play a temporary treatment role and create conditions for later treatment. |
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