| Objective:To explore the prevention methods,clinical grouping and Selection of unplanned operation of biliary tract restruction.Methods:Clinical data of 36 patients with bile duct injury admitted to our hospital from January 2016 to September 2019 were retrospectively analyzed.Two cases were found intraoperatively,and 34 cases were found postoperatively without acute peritonitis.According to clinical symptoms,17 cases were in biliary leakage group,10 cases in biliary stenosis group,and 7 cases in biliary leakage combined with biliary stenosis group.unplanned operation of biliary tract restruction was found in 2 cases intraoperatively:bile duct repair+T tube drainage,and unplanned operation of biliary tract restruction postoperatively were as follows:bile duct repair+T tube drainage in 2 cases,bile duct exploration+T tube drainage in 3 cases,cholejunostomy+T tube drainage in 12 cases,ERCP+ENBD in 6 cases,peritoneal puncture and drainage alone in 9 cases,and peritoneal puncture and drainage+PTCD in 2 cases.The causes,time of discovery and site of bile duct injury in 36 patients were analyzed.The changes of ALB,TBIL,ALT,AST and other indexes before and after each group treatment were observed and analyzed statistically.The postoperative complications and follow-up of 36 patients were observed,and the postoperative efficacy was analyzed.The quality of life of 34 patients was scored before and after the treatment,and the statistical analysis was conducted.results:(1)In this study,the common causes of bile duct injury included pathological factors(52.8%)and anatomical variation(8.3%).(2)Time of discovery:In this study,2 patients were found during opration.34 patients were found after surgery,and the mean time of discovery was about 23 days.They were divided into three groups:① In the bile leakage group,16 cases were found within 2 weeks after operation,and 1 case was found 4 months after operation.② In the bile duct stricture group,7 cases were found within 2 weeks after operation,and 3 cases were found from 2 months to 10 months after operation.③ In bile leakage combined with bile duct stricture group,6 caseswas found within 2 weeks and 1 case were found 24 days after operation.(3)In this study,2 patients were found to have damage to the hepatic duct during operation,and 34 patients with bile duct injury were found after operation.They were divided into three groups:①In the biliary leakage group,6 cases of cystic duct injury,5 cases of hepatic duct injury,4 cases of common bile duct injury,1 case of left hepatic duct injury,and 1 case of right hepatic duct injury.② In the bile duct stricture group,there were 8 cases of hepatic duct injury and 2 cases of common bile duct injury.③ There were 5 cases of hepatic duct injury and 2 cases of common bile duct injury in the group of bile leakage combined with bile duct stricture.(4)Analysis of postoperative efficacy after BDI treatment:①After treatment,ALB,TBIL,ALT and AST of the three groups all tended to be normal,while there were statistically significant differences in ALB,AST and TBIL of the bile leakage group(P<0.05).There were significant differences in TBIL,ALT and AST in the bile duct stricture group(P<0.05),the TBIL of bile leakage combined with bile duct stricture group had statistical difference(P<0.05).②All patients in this study had 5 cases of Clavien-Dindo grade III or above within 1 month after treatment of postoperative complications.The recent effective rate was 86.1%.3 days after intraoperative bile duct repair,1 case was complicated with bile duct stricture.Biliary leakage group(n=4):ERCP+ENBD was performed within 2 weeks after injury,with 1 case of abdominal abscess and 1 case of perihepatic effusion.One case of abdominal abscess was complicated by original abdominal drainage tube after injury.Bile duct repair was performed within 2 weeks after the injury,with pleural effusion in 1 case.③ In this study,7 patients with Terblanche grade III or above were followed up from 1 month to 2 years after treatment,with a long-term effective rate of 80.6%.Intraoperative bile duct repair complicated with bile duct stricture in 1 case;There were 1 patient in the Bile leakage group.Choleoenterostomy was performed 3 months after injury and anastomotic stricture was complicated.There were 2 patients in the biliary stricture group.Bile duct repair was performed 2 weeks after injury and stricture occurred in 1 case;PTCD was performed 10 days after injury with cholangitis in 1 case.There were 3 patients in the Bile leakage combined with bile duct stricture group.PTCD was performed before cholejunostomy 20 days after injury,and cholangitis was complicated in 1 case.Original abdominal drainage tube drainage after injury,long-term bile duct stricture in 2 cases.(4)In this study,the quality of life scores of 34 patients before and after treatment were found to have statistically significant differences in symptoms,physical and physiological function,daily life,social activities,psychological and emotional state and total scores(P<0.05)Conclusion:(1)The common causes of bile duct injury include pathological factors and anatomical variation,etc.The key to prevent bile duct injury is to pay attention to preoperative examination such as B ultrasound and MRCP,and intraoperative fine operation.(2)Biliary duct injury was found intraoperatively,and the commonly used unplanned operation of biliary tract restruction was biliary duct repair+T tube drainage.(3)Postoperative bile duct injury was found without acute peritonitis,and unplanned operation of biliary tract restruction was selected according to clinical grouping.①Early endoscopic or ultrasound interventional therapy is the preferred minimally invasive treatment for BDI in the bile leakage group.②In the biliary stricture group,cholejunostomy is the main treatment for BDI after bile duct dilation.③Biliary leakage combined with bile duct stricture group was mainly treated with comprehensive treatment.that is,endoscopy,ultrasound intervention and other treatment in the early stage,and then surgery after 1-3 months of drainage.(4)Endoscopic minimally invasive treatment is an important component of unplanned operation of biliary tract restruction and has broad application prospects for biliary duct injury. |
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