Repair Effects Of Operative Style And Timing After Bile Duct Injury

Objective To investigate the selection of operative timing in the Bile duct reconstruction after Bile Duct Injury(BDI) lead by cholecystectomy,and the perfect first operative style and correct operational approach,in the end,to determine the a better operative style,increase the operative effects,decrease the complications and the rate of secondary operation,also relieve the patients' pains.Methods Review the 42 clinic files of BDI lead by Cholecystectomy and which referred to the second hospital affiliated Kunming medical college between 1994 to 2008 years,including 34 Open Cholecystectomy(OC) examples,5patients underwent Laparoscopic Cholecystectomy(LC) and 3patients who underwent LC transferred to open cholecystectomy.All the examples were asked insistently by before operative history,clinical manifestation,imageology files and detection in the operation to determine the final diagnosis.Though reading and analysing the clinic files intimately,to found 13 first Choledochojejunostomy styles in the early treatment failture,and wrote down determine operative style.According to the before operative history,clinical manifestation,imageology files and detection in the operation,the patients were divided into A,B,C and D by Amsterdam classification,injury levels accord to Bismuth classification.According the first time received Cholecystectomy, whether received the bile duct reconstructive operation and the determine operative times,the patients were divided into early(A),delayed(B) and late(C),three styles to compare the operative timing,detect the outcom of short and long-term by the reconstructive timing.Follow-up through regularly outpatient visit,telephone and mail the patients or the responsive doctors. Results 4(4/8) were more than BismuthⅢin 8 patients lead by LC,there was significant deviation(P<0.05) compared with the 6(4/34) which lead by OC.The 13 patients fail treated early were all operated in the Third-level grade-A hospitals below.In the bile duct reconstructive styles,the Roux-en-Y Choledochojejunostomy is the best in the long term effect.The compared in the three groups,the rates of peritoneal abscess and postoperative strictures in the early treated patients is more than the delayed and late treated patients(P≤0.05).Conclusion The level of BDI that lead by LC was high,injury results were complicated,difficult to repair early,need to more take care of.the rates of peritoneal abscess and postoperative strictures in the early treated patients is more than the delayed and late treated patients(P<0.05).The patients not treated by biliary surgeon always were fault the best operative opportunity,error operative style and wrong operational approach,secondary operation was high.The patients who were treated by biliary surgeon were low secondary operation opportunity,correct operative time could decrease the rate of secondary operation.