Extrahepatic bile duct injury

[Outlined -- traumatic extrahepatic bile duct injury, hepatic portal is part of the injury. As the extrahepatic bile duct were deeper, more important around the blood vessels and organs. The role of outside powers under simply see less of bile duct injury, most accompanied by the portal vein, inferior vena cava, liver, pancreas, stomach, duodenum, and other damage. As with the internal bleeding caused by shock or gastrointestinal perforation caused by peritonitis, easy to hide the performance of bile duct injury. Once missed, will become a serious bile peritonitis, abdominal secondary infections, life-threatening, even to be saved, bile leakage and stenosis of the bile duct is also very complicated. [Diagnosis -- general diagnosis is not difficult, obviously biliary obstruction, percutaneous transhepatic cholangiography (PTC) in the diagnosis of the most helpful, Diagnosis and clearly identify the site of obstruction, to preoperative surgical planning. If there fistula, through fistula for angiography, but often can not show the whole picture of biliary tract. ERCP is better value in the diagnosis of PTC, generally not very good show proximal to the obstruction of the bile duct. [Treatment] abdominal trauma caused by extrahepatic bile duct injury depends on the seriousness of the treatment, such as the merger of organ injury, blood loss, Intraperitoneal pollution, as well as medical conditions and technical strength. Damage to the heavy loss of blood to the wounded should be more active anti-shock, but quickly took control active bleeding, or excision repair organ damage. Complex biliary injury rehousing first "T" tube drainage, the seriousness of stability after elective surgery for bile duct repair. Injuries and if conditions permit, and iatrogenic bile duct injury, according to the following principles : CBD should carefully laceration repair than the verge of tears without vigor, in the proximal or distal gap for all other mouth Size appropriate placement of a "T" - shaped tube, the arm through the gap so as bracing, and then split suture thread. If laceration over weeks or more than half Drive bile duct has completely broken, should be repaired and in the absence of tension with the conditions 5-0 nylon yarn or thread small defy end anastomosis. and the same approach with the above placement "T" pipe as support. "T" of the general retention time than six months. If agreement tension and avoid reluctantly roped, low gap with the duodenum, even at the peak gap of about liver bile duct can be implemented or Hepaticojejunostomy Y-shaped anastomosis. Biliary reconstruction success will depend on skilled techniques, fine debridement surgery, anastomotic mucosa technique Fine debridement surgery, anastomotic mucosa with the accuracy of tension and no agreement. Gallbladder or cystic duct laceration fracture simple and reliable treatment is cholecystectomy. After proper drainage, avoid abdominal infection is an important measure. [Etiology -- extrahepatic bile duct injury in fact to less than 20% of iatrogenic injury. Its incidence is about 0.3~0.5%, about 200-300 times cholecystectomy a meeting occurred. Bile duct injury was part of the operation have been found and was properly handled, Unfortunately, the other part after the detection of serious complications, resulting in processing difficulties, but also the therapeutic effect. Extrahepatic bile duct injury occurred in the majority of cholecystectomy. in the minority to carry out complex subtotal gastrectomy were cut off and the closure of the duodenum when bile duct injury, also be in the common bile duct or the removal of around ampulla of duodenal diverticula when bile duct injury. Analysis of cholecystectomy caused when the bile duct injury reasons : surgical errors If intraoperative bleeding when suddenly blind hemostatic forceps or suture large bleeding; cut off the cystic duct excessive traction of the gallbladder, and to the common bile duct or common hepatic duct mistaken for cystic duct ligation be cut off, and so on. Biliary anatomy abnormality such as cystic duct very short, or their absence in the right hepatic duct openings. If surgery is not possible to identify the risk of injury. Serious inflammation, adhesion local close, anatomy, during the operation can also lead to inadvertent injury. Deserves attention is sometimes not such objective factors exist, but in ordinary cholecystectomy is a bile duct injury, which requires the person to identify themselves to the cause. As for abdominal trauma caused by bile duct injury associated with the majority of macrovascular and adjacent organ damage. [Pathogenesis -- damaged bile duct completely fault or defect, can only be vascular clamp squeezing or suture a result bile leakage inflammation and fibrosis. Finally the bile duct stenosis or occlusion. Stenosis or occlusion of the proximal bile duct dilatation, wall thickening; Remote can also be wall thickening, luminal narrowing or occlusion. Biliary stenosis or occlusion after discharge blocked bile duct pressure increased, cholestasis, such as duration, Liver cells will be irreversible damage; Cholestasis also Gram-negative enteric bacilli secondary infection, cholangitis caused repeated attack, the results of which will add to the liver cell damage caused cirrhosis. Accompanied by bile leakage, liver damage, while the lighter, However, it is often secondary bile or abdominal infection often caused substantial loss of digestion and absorption problems. [Clinical manifestations -- bile duct injury depends on the clinical manifestations of the extent of an injury, the severity of stenosis and whether bile leakage. Major features of the biliary fistula and / or obstructive jaundice. Patients after injury or how volume outflow of bile from the wound, when the outflow of bile reduced after upper abdominal pain, fever and jaundice. We also have the appearance shortly after the gradual deepening of jaundice, right upper quadrant accompanied by persistent pain and fever. 【Bile duct injury prevention -- the consequences are serious, to prevent their occurrence is very important. In fact the vast majority of iatrogenic bile duct injuries can be prevented, surgical operation should focus our attention operation to carefully and abide by the operation of conventional steps, such as the implementation of cholecystectomy, the first show of common bile duct, hepatic duct and cystic duct and evil and the relationship between the three after the string used to trap the cystic duct, and not be cut off. From the bottom of gallbladder retrograde cholecystectomy separation direct cystic duct into the common bile duct, this time can cut off the cystic duct ligation. If the separation cystic duct when these three relations confusing, considering the common bile duct technique, and the insertion detection pole, help determine the location of the bile duct. Also for intraoperative cholangiography to help locate. In addition, the separation of the gallbladder should be as close as possible when the gallbladder wall shear, the event should be carefully hemorrhagic bleeding, avoid large suture bleeding, alert and whether the existence of biliary malformations.