Analysis Of Risk Factors Of Biliary Stricture After Repair Of Iatrogenic Biliary Tract Injury

Objective:The purpose of this study is to explore the related risk factors of biliary stricture after IBDI repair,to provide prevention and treatment experience for reducing the occurrence of biliary stricture after repair,and to better guide clinical practice.Methods:In this study,a retrospective study was conducted to collect the clinical data of 52 patients with iatrogenic bile duct injury after cholecystectomy in Hunan people’s Hospital from October 2011 to October 2020.including general data,blood sampling results,imaging results and other data.Patients with IBDI were divided into biliary stricture group and non-biliary stricture group according to whether biliary stricture occurred in the long term after biliary repair.To study and analyze the related factors of biliary stricture after IBDI repair,including sex,age,site of injury,Surgical repair before referral,diabetes,vascular injury,biliary cirrhosis,preoperative ALT level,preoperative TB level,referral time,preoperative sepsis,repair mode,combined hepatectomy,preoperative bile leakage,repair suture selection,operation duration,postoperative hospital stay,Recent serious complications(above Clavien-Dindo III grade).The related factors mentioned above were analyzed by univariate analysis,and the related factors affecting the patient’s biliary tract stricture were further analyzed by multivariate binary logistic regression analysis,and the independen risk factors of biliary stricture after IBDI repair were obtained.Result:52 patients with IBDI were included in this study,and 13 patients(25.0%)had recent complications above Clavien-Dindo grade III after operation.The median follow-up period was 46 months(IQR 3-108months).34 cases(65.3%)showed good long-term prognosis of Terblanche grade Ⅰ and Ⅱ,and 18 cases(34.7%)of Terblanch grade Ⅲ andⅣ,of which 14 cases(27.0%)had biliary stricture and needed surgical treatment.Through univariate analysis of the correlation factors between the patients with biliary stricture after IBDI repair and those without biliary stricture,it was concluded that there were significant differences between preoperative sepsis(p=0.010),surgical repair before referral(p=0.008),postoperative hospital stay ≥ 15 days(p=0.033)and biliary stricture after IBDI biliary repair.Multivariate analysis showed that preoperative sepsis(OR 2.481,95% CI [1.853-22.538],P=0.012)and Surgical repair before referral(OR 3.684,95% CI [1.125-14.752],p=0.032)were independent risk factors for long-term biliary stricture after IBDI repair.Conclusion:1.The presence of Preoperative sepsis indicates the presence of local infection,which is an independent risk factor for biliary stricture after IBDI repair.2.Surgical repair before referral is another independent risk factor for biliary stricture after IBDI repair.Blind repair before referral should be avoided and should be repaired by experienced hepatobiliary specialists,which is very important.3.Postoperative hospital stay ≥ 15 days may be significantly related to biliary stricture after IBD repair.