Analysis Of Different Treatment Methods For Type Ⅱ Bile Duct Injury After Cholecystectomy

Objective:To explore the clinical efficacy of endoscopic treatment and surgical treatment in the same classification of iatrogenic bile duct injury.Methods:The clinical data of patients with iatrogenic bile duct injury admitted to the First Affiliated Hospital of Xinjiang Medical University from February 2017 to February 2022 were retrospectively analyzed and divided into endoscopic treatment group(17 cases)and surgical treatment group(29 cases)according to the different treatment modalities.The number of hospital days,hospital costs,preoperative and postoperative laboratory indices,intraoperative bleeding,operative time,postoperative complications and post-discharge follow-up of patients in both groups were compared.Results:There was no statistically significant difference in the basic preoperative data between the two groups(P>0.05).However,on the first day after surgery,the total bilirubin and direct bilirubin levels in the endoscopic treatment group were lower than those in the surgical treatment group,and the difference between the two groups was statistically significant(P<0.05).In the comparison of intraoperative related conditions the operating time and intraoperative bleeding were lower in the endoscopic treatment group than in the surgical treatment group,and the total number of days of hospitalization and the total cost of hospitalization were less in the endoscopic treatment group than in the surgical treatment group(P<0.05).The difference in the timing of repair between the two groups was statistically significant(P<0.05).The patients were followed up for 2.5-67.7 months,with a median follow-up time of 32.1months.The follow-up efficiency rate was 89.1%.During the follow-up period,short-term complications were evaluated with Clavien-Dindo≥grade III as serious complications,including 5 cases in the endoscopic treatment group and 14 cases in the surgical treatment group.Terblanche grading criteria were used for long-term complications,with 14 cases of excellent Terblanche rating and 1 case of poor rating in the endoscopic treatment group and 19 cases of excellent rating and 5 cases of poor rating in the surgical treatment group.Conclusion:In the treatment of type II IBDI,the endoscopic treatment group has faster overall recovery of liver function and significant therapeutic effects,shorter postoperative hospital stay,fewer postoperative complications,and lower reoperation rate,and is generally superior to the surgical treatment group as the preferred treatment modality.In case of immediate intraoperative detection of IBDI,transection injury of the bile duct and associated vascular injury,surgical treatment is still the preferred treatment for this type of IBDI.