extrahepatic bile duct injury
Introduction
Introduction to extrahepatic bile duct injury Extrahepatic bile duct injury caused by trauma is part of the hilar injury. Because the extrahepatic bile duct is deeper and there are more important blood vessels and organs around it, simple bile duct injury is less common under the action of external force, most of which are accompanied by portal vein, inferior vena cava, liver, pancreas, stomach, duodenum. Such damage. Peritonitis caused by shock or gastrointestinal perforation caused by internal bleeding, easy to cover the performance of bile duct injury, once missed diagnosis, will lead to severe biliary peritonitis, secondary abdominal infection, life-threatening, even if saved, bile leakage and biliary tract The narrow handling is also very complicated. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis shock
Cause
Causes of extrahepatic bile duct injury
Extrahepatic bile duct injury is actually more common in iatrogenic injury, the incidence rate is about 0.3 ~ 0.5%, that is, about 200 times in 200 to 300 cholecystectomy, part of the bile duct injury was found at the time of surgery. It was handled properly, and unfortunately another part was discovered after surgery, causing serious complications, causing difficulty in treatment and affecting the treatment effect. The majority of extrahepatic bile duct injury occurred in cholecystectomy, and a few occurred in the implementation. In the complicated partial gastrectomy, the bile duct is accidentally injured when the duodenum is cut and closed. It can also occur when the common bile duct incision is performed or the duodenal diverticulum around the ampulla is removed. The common bile duct is injured. Analysis of cholecystectomy Causes of bile duct injury:
Surgical operation error (25%):
If sudden bleeding occurs during surgery, blind force clamps to stop bleeding or large sutures to stop bleeding; when the cystic duct is cut, the gallbladder is excessively pulled, and the common bile duct or common hepatic duct is mistaken for the cystic duct to be cut and ligated.
Anatomical malformation of the biliary system (17%):
If the cystic duct is extremely short, absent or its opening in the right hepatic duct, etc., if it is not recognized during surgery, it may cause injury.
Severe inflammation (10%):
Inflammation is severe, local adhesions are tight, and the anatomy is unclear. Inadvertent operation may cause accidental injury during surgery. It is worth noting that sometimes there is no such objective factor, but bile duct injury also occurs in ordinary cholecystectomy. This requires finding the cause from the surgeon itself. Most of the bile duct injuries caused by abdominal trauma are accompanied by damage to large blood vessels and adjacent organs.
Prevention
Extrahepatic bile duct injury prevention
The consequences of bile duct injury are serious, so it is very important to prevent its occurrence. In fact, most of the 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. Steps, such as in the implementation of cholecystectomy, first reveal the common bile duct, the common hepatic duct and the cystic duct, identify the relationship between the three, use the silk thread to cover the cystic duct, temporarily cut it off, and then perform retrograde gallbladder separation from the bottom of the gallbladder to the gallbladder The tube is merged into the common bile duct, and then the cystic duct is ligated. If the relationship between the three tubes is unclear when separating the cystic duct, the common bile duct incision can be considered, and the probe is placed to help determine the position of each bile duct. It can also be used for intraoperative cholangiography to help locate. 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 massive sutures to stop bleeding, and always be alert to the presence of bile duct malformation.
Complication
Extrahepatic bile duct injury complications Complications peritonitis shock
Can be complicated by peritonitis, shock and other organ damage embolism.
Symptom
Extrahepatic bile duct injury symptoms common symptoms upper abdominal pain jaundice persistent pain bile duct fracture biliary obstruction
The clinical manifestations of bile duct injury depend on the extent of the injury, the severity of the stenosis and the presence or absence of biliary leakage, mainly manifested as biliary fistula and/or obstructive jaundice. Patients have a large amount of bile flowing out of the wound after injury or after surgery, when bile After the outflow was reduced, there was upper abdominal pain, fever and jaundice. There was also a gradual deepening of jaundice soon after the operation, accompanied by persistent pain and fever in the right upper quadrant.
Examine
Examination of extrahepatic bile duct injury
1. Diagnostic abdominal puncture or peritoneal lavage, with positive results.
2. B-type ultrasound, X-ray chest and abdomen plain film, MR can assist in diagnosis.
Diagnosis
Diagnosis and diagnosis of extrahepatic bile duct injury
Diagnosis is generally not difficult. Percutaneous transhepatic cholangiography (PTC) is the most helpful for the diagnosis of biliary obstruction. It can be used to determine the diagnosis and clear the obstruction site. It is conducive to the development of surgical plans before surgery. Oral angiography, but often can not show the overall appearance of the biliary tract, the diagnostic value of ERCP is not as large as PTC, generally can not show the bile duct in the proximal side of the obstruction.
Differential diagnosis
1. Cholecystitis.
2 other hepatic hilum injuries.
