Surgical treatment of iatrogenic bile duct injury: a report of 27 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 TAN Zhenhua , XIE Ping , QIAN Hai

Department of General Surgery, Central Hospital of Huzhou City, Huzhou, Zhejiang 313000, P.R.China;

Corresponding?author：

TAN Zhenhua, Email: tanzh99@163.com

Keywords：

iatrogenic bile duct injury; classification; treatment

DOI：

10.7507/1007-9424.201702072

Video：

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Objective To summarize the classification, diagnosis, and treatment of iatrogenic bile duct injury. Method The clinical data of 27 cases of iatrogenic bile duct injuries who treated in Central Hospital of Huzhou City from 2008–2013 were retrospectively analyzed. Results The classification of 27 cases: 5 cases of type Ⅰ, 18 cases of type Ⅱ, 2 cases of type Ⅲ, 2 cases of type Ⅳ. Diagnosis: 11 cases were immediately discovered at the time of the initial operation, include 1 case of type Ⅰ, 8 cases of type Ⅱ, 1 case of type Ⅲ, 1 case of type Ⅳ; 10 cases were detected in early stage after the initial operation, include 2 cases of type Ⅰ, 7 cases of type Ⅱ, 1 case of type Ⅲ; 6 cases were detected in delayed stage after the initial operation, include 2 cases of type Ⅰ, 3 cases of type Ⅱ, 1 case of type Ⅳ. Treatment effect: 17 cases for excellent, 5 cases for good, 4 cases for bad, the well recover rate was 84.6% (22/26). One case died after operation. A total of 26 cases were followed up, 1 case was lost to follow up. During the follow-up period, bile leakage occurred in 3 cases, infection of incision occurred in 2 cases, cholangitis occurred in 3 cases, and bile duct stricture occurred in 2 cases. Conclusions The best time of repairing for the iatrogenic bile duct injuries is at the time of the initial operation or early stage. According to the type of injury and the time of the injury was diagnosed, timely and effective treatment by intervention and (or) surgery is the key.

Citation： TAN Zhenhua, XIE Ping, QIAN Hai. Surgical treatment of iatrogenic bile duct injury: a report of 27 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 271-274. doi: 10.7507/1007-9424.201702072 Copy

1.	?黃志強. 手術后肝外膽道狹窄 (一). 實用外科雜志, 1998, 8(4): 195-197.
2.	黃志強. 膽管損傷: 肝膽外科永久的議題. 中華普通外科雜志, 2001, 16(6): 371-373.
3.	王敬, 周寧新, 段云鵬. 醫源性膽管損傷早期處理失敗的原因分析. 中國實用外科雜志, 2004, 24(9): 557-559.
4.	劉允怡. 醫源性膽道損傷的分類. 中華肝膽外科雜志, 2005, 11(3): 149-150.
5.	段建平, 廖宣明, 梅建民, 等. 醫源性膽道損傷的預防及處理. 中國實用外科雜志, 2007, 27(7): 546-548.
6.	Buell JF, Cronin DC, Funaki B,et al. Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch Surg, 2002, 137(6): 703-710.
7.	中華醫學會外科學分會膽道外科學組. 膽管損傷的診斷與治療指南 (2013 版). 中華消化外科雜志, 2013, 12(2): 81-95.
8.	Liverani A, Correnti SF, Paganelli MT,et al. Benign biliary stricture. Personal experience and technical notes. Minerva Chir, 1999, 54(3): 117-122.
9.	Vitale GC, Tran TC, Davis BR,et al. Endoscopic management of postcholecystectomy bile duct strictures. J Am Coll Surg, 2008, 206(5): 918-925.
10.	董家鴻. 醫源性膽管損傷及損傷性膽道狹窄的現代外科處理. 中華消化外科雜志, 2008, 7(1): 6-8.
11.	Joseph M, Phillips MR, Farrekk TM,et al. Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution. Ann Surg, 2012, 256(1): 1-6.
12.	白雪巍, 孫備, 劉杰, 等. 醫源性膽管損傷再手術時機對預后的影響. 中華肝膽外科雜志, 2011, 17(9): 703-706.
13.	寇桂香, 柴琛. 醫源性膽管損傷的臨床診治進展. 中國普外基礎與臨床雜志, 2014, 21(10): 1321-1324.

1. ?黃志強. 手術后肝外膽道狹窄 (一). 實用外科雜志, 1998, 8(4): 195-197.
2. 黃志強. 膽管損傷: 肝膽外科永久的議題. 中華普通外科雜志, 2001, 16(6): 371-373.
3. 王敬, 周寧新, 段云鵬. 醫源性膽管損傷早期處理失敗的原因分析. 中國實用外科雜志, 2004, 24(9): 557-559.
4. 劉允怡. 醫源性膽道損傷的分類. 中華肝膽外科雜志, 2005, 11(3): 149-150.
5. 段建平, 廖宣明, 梅建民, 等. 醫源性膽道損傷的預防及處理. 中國實用外科雜志, 2007, 27(7): 546-548.
6. Buell JF, Cronin DC, Funaki B,et al. Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch Surg, 2002, 137(6): 703-710.
7. 中華醫學會外科學分會膽道外科學組. 膽管損傷的診斷與治療指南 (2013 版). 中華消化外科雜志, 2013, 12(2): 81-95.
8. Liverani A, Correnti SF, Paganelli MT,et al. Benign biliary stricture. Personal experience and technical notes. Minerva Chir, 1999, 54(3): 117-122.
9. Vitale GC, Tran TC, Davis BR,et al. Endoscopic management of postcholecystectomy bile duct strictures. J Am Coll Surg, 2008, 206(5): 918-925.
10. 董家鴻. 醫源性膽管損傷及損傷性膽道狹窄的現代外科處理. 中華消化外科雜志, 2008, 7(1): 6-8.
11. Joseph M, Phillips MR, Farrekk TM,et al. Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution. Ann Surg, 2012, 256(1): 1-6.
12. 白雪巍, 孫備, 劉杰, 等. 醫源性膽管損傷再手術時機對預后的影響. 中華肝膽外科雜志, 2011, 17(9): 703-706.
13. 寇桂香, 柴琛. 醫源性膽管損傷的臨床診治進展. 中國普外基礎與臨床雜志, 2014, 21(10): 1321-1324.

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Surgical treatment of iatrogenic bile duct injury: a report of 27 cases

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