The Discussion Of Risk Factors And Prevention Measures Of The Iatrogenic Trauma In End Part Of Common Bile Duct

ObjectiveTo investigate the risk factors and prevention measures of the iatrogenic trauma in end part of common bile duct(CBD).MethodsAll Chinese articles about the iatrogenic trauma in end part of CBD from December 2000 to December 2015 through China National Knowledge Infrastructure(CNKI) were reviewed and the ones without original data were deleted. Totally 179 cases of the distal CBD injuries from 28 medical units were adopted. The clinical data of 8 cases of iatrogenic distal CBD injuries admitted Department of Hepatobiliary Surgery of First Affiliated Hospital of Chongqing Medical University from December 2000 to December 2015 were retrospective analyzed. Making form, recording and analyzing the original data were followed by..Results90.3% of the iatrogenic trauma in end part of CBD was related to the biliary tract surgical exploration; Of these cases, choledocholithiasis with calculus incarcerated, jaundice, stenosis account for 84.8% and the simple choledocholithiasis account for only 15.2%. Of all these cases, back wall and inner wall damage were in the majority, were 55.9% and 25.4% respectively. Anterior wall and Vater papilla were followed by. 79.2% of the intraoperative diagnosis of distal CBD injuries depend on the performer’s perception to judge firstly and the character of drainage liquid was the earliest evidence to 54.8% of the postoperative diagnosis. 136 cases of the iatrogenic trauma in end part of CBD were found in the operation, and the incidence of complications was 18.4%, mainly for bile leakage, intestinal leakage, pancreatic leakage, infection, hemorrhage. The incidence of secondary surgery was 1.5%. 34 cases of the distal CBD injuries were found after the operation, and the incidence of complications was 41.2%, mainly for hemorrhage, bile leakage, pancreatic leakage,infection,. The incidence of secondary surgery was 17.6%. During 9 months to 7 years follow-up period, only 2 cases of recurrent abdominal pain, 2 cases of accidental cholangitis, were both the postoperative patients who were diagnosed the distal CBD injuries.Conclusions1. Of the cases of trauma in end part of CBD, biliary tract surgical exploration was still account for the vast majority.2. The specific anatomic structure, pathological change and the use of choledochoscope were the factors that the end part of CBD was easy to damage.3. The performer’s perception and the character of drainage liquid were very important to determine the presence of distal CBD injuries.4. Discovering and processing in time during the operation were the most important and the complications, morality and reoperation rate was low compare to the postoperative therapies.5. No matter what kind of remedy measures can achieve good results to these patients who were diagnosed distal CBD injuries during the operation. The previous simple drainage operation was the best choice to the postoperative patients who were diagnosed distal CBD injuries.