Benign stricture of bile duct
Introduction
Introduction to benign biliary stricture Refers to bile duct injury and recurrent cholangitis caused by scarring of the bile duct scar, can be caused by iatrogenic injury, abdominal trauma and bile duct stones, infection, affected bile duct due to repeated inflammation, bile salt stimulation, leading to fibrous tissue hyperplasia, wall Thickening, narrowing of the bile duct. In turn, biliary obstruction, pathological and clinical manifestations of infection appear. Iatrogenic bile duct stricture refers to postoperative bile duct stricture caused by surgical injury or surgery-related factors (such as bile duct blood supply disorder, bile leakage, inflammation, etc.). In recent years, due to the widespread use of B-ultrasound and cholecystectomy, especially the widespread development of laparoscopic cholecystectomy, the incidence of iatrogenic bile duct stricture has increased significantly, which has attracted the attention of the Chinese surgical community. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: sepsis
Cause
Causes of benign biliary stricture
Caused by iatrogenic injury, abdominal trauma and bile duct stones, infection.
Prevention
Prevention of benign biliary stricture
Medical staff in medical work should reduce the occurrence of iatrogenic injuries in strict accordance with the operating procedures; Develop good habits to avoid abdominal trauma; actively treat primary diseases such as bile duct stones infection. The consequences of bile duct injury are serious, so it is important to prevent it from happening. In fact, the vast majority of iatrogenic bile duct injury can be prevented. The surgeon should concentrate on the operation, the operation should be careful and meticulous, and follow certain operational routines. For example, when performing cholecystectomy, the common bile duct is revealed first. The common hepatic duct and the cystic duct are used to identify the relationship between the three, and the cystic duct is covered with a silk thread, and the cystic duct is not cut off. Then the retrograde gallbladder is separated from the bottom of the gallbladder and the cystic duct is transferred to the common bile duct. At this time, the cystic duct is cut and ligated. If the above three tube relationships are unclear when separating the cystic duct, consider a common bile duct incision and insert a probe to help determine the position of each bile duct. Intraoperative cholangiography can also be used to help with positioning. In addition, when separating the gallbladder, it should be cut as close as possible to the wall of the gallbladder. In case of bleeding, it should be carefully stopped to stop bleeding. Avoid large-scale sutures to stop bleeding, and always be alert to the presence of bile duct malformation.
With the accumulation of treatment experience and lessons, the concept of focusing on prevention is being promoted by more and more surgeons. In the upper abdominal surgery, carelessness is the first link in the biliary injury. Landibous believes that 2/3 of the biliary tract injuries are caused by experienced surgeons. Anatomical variation is an important cause of intraoperative biliary injury. Of course, the inexperience of quite a few surgeons is another important reason. Currently, laparoscopic cholecystectomy has become the preferred procedure for cholecystectomy. After introduction of laparoscopic cholecystectomy, iatrogenic biliary injury showed an increasing trend. Indeed, there is a learning process for mastering this procedure, but it should not be at the expense of the patient's suffering. There are many related literatures on how to prevent biliary tract injury during surgery. It is worth mentioning that some large hospitals in modern China are already implementing the qualification system for medical surgery. For example, Peking Union Medical College Hospital has clearly defined the operation qualification of laparoscopic cholecystectomy, including the level of the surgeon, the number of previous main laparoscopic cholecystectomy, and the number of previous laparoscopic cholecystectomy. and many more. The fundamental purpose of the physician's surgical qualification access system is to eliminate the occurrence of iatrogenic injury from the source, which should be promoted nationwide.
Complication
Complications of benign biliary stricture Complications sepsis
In severe cases, the disease develops rapidly, rapidly deteriorates, and ACST and sepsis appear.
Symptom
Symptoms of benign biliary stricture Common symptoms Hepatomegaly fever Upper abdominal pain Portal hypertension High white stool Yellow sputum Irregular hot gallbladder hypersensitivity Gallbladder hydrocephalus rupture
History
Have a history of biliary tract, upper abdominal surgery (trauma), or a history of recurrent cholangitis,
1 surgery (injury) within 24 hours after the occurrence of obstructive jaundice, or drainage mouth overflowing a large number of bile, or surgery (injury) early asymptomatic, intermittent after a few weeks to several years of dull pain, chills and fever, jaundice, The stool is gray, etc.
2 There may be a Charcot triad at the time of acute attack.
3 chronic patients have long-term jaundice, irregular heat type, jaundice deepened after fever, biliary cirrhosis, or cholangitis without jaundice, severe cases of rapid development, rapid deterioration, ACST, sepsis and so on.
2. Signs
1 upper abdominal tenderness during the attack,
2 jaundice,
3 hepatomegaly, tenderness,
4 can have signs of portal hypertension and so on.
Examine
Examination of benign biliary stricture
1. White blood cells, the number of neutrophils increased; the test showed obstructive jaundice; liver function damage, white, globulin ratio inverted; blood culture can be positive.
2. Retrograde cholangiography, PTC, ERCP, can show the stenosis, morphology and extent, bile duct is not developed, can not exclude bile duct stricture, sometimes venous cholangiography, can also show lesion bile duct.
3. B-mode ultrasound can show the proximal biliary dilatation of the stenosis, or (and) the sonogram of the stone.
Diagnosis
Diagnosis and differentiation of benign biliary stricture
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Cholecystitis
Cholangitis
