Anatomic Factors Associated with Iatrogenic Biliary Injury_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GE Jiayun ¹ , ZOU Hao ¹ , LI Tianzhu ² , WANG Lin ¹ , LUO Ping ³

1.Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical College, Kunming 650101, China;;
2.Department of Surgery, People’s Hospital of Fuming Country, Fuming 650400, Yunnan Province, China;;
3.Department of Surgery, People’s Hospital of Dongguan City, Dongguan 523018, Guangdong Province, China;

Corresponding author：

Keywords：

Iatrogenic biliary injury; Stenosis of biliary duct; Anatomic factor

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Objective To investigate the anatomic factors on iatrogenic biliary injury for elevating surgical safety and decreasing incidence of iatrogenic biliary injury. Methods The clinical data of 39 patients with iatrogenic biliary injury and anatomic varied factors in operation records from January 2000 to August 2009 in The Second Affiliated Hospital of Kunming Medical College were analyzed retrospectively. Results Thirty-nine patients with iatrogenic biliary injury were divided into 5 types according to Bismuth typing, including type Ⅰ 6 cases, type Ⅱ 19 cases, type Ⅲ 8 cases, type Ⅳ 5 cases, and type Ⅴ 1 case. Anatomic varied factors included bile duct variation in 15 cases, cystic duct abnormal position in 10 cases, vascular variation in 13 cases, and porta hepatis rotation in 1 case. Biliary injuries were found during operation in 6 cases, 24—72 h after operation in 16 cases, and stenosis of biliary duct was found in 17 cases 3 months to 2 years after operation. Two cases were dead because of liver function failure or myocardial infarction, withdraw was 4, the other patients were cured. Conclusion Anatomic factors are important objective elements in iatrogenic biliary injury, paying attention to abnormal anatomic factors can effectively prevent iatrogenic biliary injury.

Citation： GE Jiayun,ZOU Hao,LI Tianzhu,WANG Lin,LUO Ping. Anatomic Factors Associated with Iatrogenic Biliary Injury. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 581-585. doi: Copy

1.	刘辰, 刘永锋. 预防与处理医源性胆道狭窄 [J]. 肝胆外科杂志, 1997; 5(3): 138-140.
2.	黄志强. 医源性胆管损伤: 老问题新意义 [J]. 中国实用外科杂志, 1999; 19(8): 451-452.
3.	王炳煌. 腹腔镜胆囊切除胆管损伤 [J]. 中华肝胆外科杂志, 2005; 11(3): 155-157.
4.	崔江云, 邹浩, 李越华. 胆管良性疾病再手术原因与诊治分析(附91例报告) [J]. 中国普外基础与临床杂志, 2008; 15(2): 130-131.
5.	Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment [J]. World J Surg, 2001; 25(10): 1241-1244.
6.	刘国礼. 我国腹腔镜外科的现状―156 820例腹腔镜手术综合报告 [J]. 中华普通外科杂志, 2001; 16(9): 562-564.
7.	蔡德亨, 章中春. 副肝管的外科解剖 [J]. 临床解剖学杂志, 1987; 5(3): 127-128.
8.	何生, 李茂德. 医源性胆管损伤的解剖和病理基础 [J]. 中华肝胆外科杂志, 2002; 8(6): 334-337.
9.	高志清. 注意胆道解剖变异,减少医源性胆管损伤 [J]. 临床外科杂志, 1995; 3(6): 283-285.
10.	汪涛, 沈志勇. 腹腔镜胆囊切除胆管损伤的原因及预防 [J]. 中国普外基础与临床杂志, 2009; 16(4): 317-318.
11.	Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective [J]. Ann Surg, 2003; 237(4): 460-469.
12.	陈训如. 腹腔镜胆囊切除术中损伤胆管的重要因素-短胆囊管 [A]. 中国微创外科杂志编辑委员会. 2007年全国微创外科论坛论文汇编 [C]. 2007: 12-14.
13.	向国安, 陈规划, 刘灏, 等. 腹腔镜胆囊切除胆管损伤23例临床分析 [J]. 肝胆外科杂志, 2004; 12(4): 252-254.
14.	尹辉新, 彭毅, 熊沛, 等. 1 600例腹腔镜胆囊切除术无胆管损伤的临床体会 [J]. 中国内镜杂志, 2008; 14(6): 649-651.
15.	周海兰, 王俊, 刘冀宁, 等. 腹腔镜胆囊切除术胆管损伤并发症及其防治 [J]. 湖南医学, 2001; 18(1): 40-41.
16.	耿远兴, 耿莉. Mirizzi综合征术中胆管损伤原因及处理对策 [J]. 中国普外基础与临床杂志, 2006; 13(1): 55.
17.	周新华, 李宏, 陆才德, 等. 腹腔镜胆囊切除术中预防胆管损伤的经验(附2 694例报告) [J]. 中国普外基础与临床杂志, 2003; 10(5): 499-450.
18.	赖良, 张旭. 腹腔镜胆囊切除术胆管损伤的预防(附8例报告) [J]. 中国普外基础与临床杂志, 2006; 13(4): 394-395.
19.	王俭, 安宁, 郑波, 等. 腹腔镜胆囊切除术中不同类型胆管损伤的处理 [J]. 中国普外基础与临床杂志, 2008; 15(2): 128-129.
20.	张启瑜. 钱礼腹部外科学 [M]. 北京: 人民卫生出版社, 2006: 601.
21.	周永碧, 巫北海. 逆行胰胆管造影发现胆囊管变异的临床意义 [J]. 中华外科杂志， 1990; 28(6): 328-330.
22.	龚建平, 韩本立, 周永碧, 等. 胆囊管异常汇合的诊断及其在腹腔镜胆囊切除术中的意义 [J]. 中国普外基础与临床杂志, 2001; 8(2): 85-87.
23.	李松林, 任作航. 胆囊动脉变异与腹腔镜胆囊切除术 [J]. 腹腔镜外科杂志, 2002; 7(1): 13-14.
24.	崔宏. 解剖变异与医源性胆管损伤关系的临床研究 [J]. 医药论坛杂志, 2003; 24(16): 31-33.　.
25.	袁家天, 吕波, 邹志强, 等. 腹腔镜胆囊切除术胆管损伤的预防 [J]. 华西医学, 2009; 24(5): 1079-1081.
26.	唐振华, 黄建华, 张裕华, 等. 医源性胆管损伤临床分析(附27例报告) [J]. 肝胆外科杂志, 2002; 10(6): 437-439.

1. 刘辰, 刘永锋. 预防与处理医源性胆道狭窄 [J]. 肝胆外科杂志, 1997; 5(3): 138-140.
2. 黄志强. 医源性胆管损伤: 老问题新意义 [J]. 中国实用外科杂志, 1999; 19(8): 451-452.
3. 王炳煌. 腹腔镜胆囊切除胆管损伤 [J]. 中华肝胆外科杂志, 2005; 11(3): 155-157.
4. 崔江云, 邹浩, 李越华. 胆管良性疾病再手术原因与诊治分析(附91例报告) [J]. 中国普外基础与临床杂志, 2008; 15(2): 130-131.
5. Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment [J]. World J Surg, 2001; 25(10): 1241-1244.
6. 刘国礼. 我国腹腔镜外科的现状―156 820例腹腔镜手术综合报告 [J]. 中华普通外科杂志, 2001; 16(9): 562-564.
7. 蔡德亨, 章中春. 副肝管的外科解剖 [J]. 临床解剖学杂志, 1987; 5(3): 127-128.
8. 何生, 李茂德. 医源性胆管损伤的解剖和病理基础 [J]. 中华肝胆外科杂志, 2002; 8(6): 334-337.
9. 高志清. 注意胆道解剖变异,减少医源性胆管损伤 [J]. 临床外科杂志, 1995; 3(6): 283-285.
10. 汪涛, 沈志勇. 腹腔镜胆囊切除胆管损伤的原因及预防 [J]. 中国普外基础与临床杂志, 2009; 16(4): 317-318.
11. Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective [J]. Ann Surg, 2003; 237(4): 460-469.
12. 陈训如. 腹腔镜胆囊切除术中损伤胆管的重要因素-短胆囊管 [A]. 中国微创外科杂志编辑委员会. 2007年全国微创外科论坛论文汇编 [C]. 2007: 12-14.
13. 向国安, 陈规划, 刘灏, 等. 腹腔镜胆囊切除胆管损伤23例临床分析 [J]. 肝胆外科杂志, 2004; 12(4): 252-254.
14. 尹辉新, 彭毅, 熊沛, 等. 1 600例腹腔镜胆囊切除术无胆管损伤的临床体会 [J]. 中国内镜杂志, 2008; 14(6): 649-651.
15. 周海兰, 王俊, 刘冀宁, 等. 腹腔镜胆囊切除术胆管损伤并发症及其防治 [J]. 湖南医学, 2001; 18(1): 40-41.
16. 耿远兴, 耿莉. Mirizzi综合征术中胆管损伤原因及处理对策 [J]. 中国普外基础与临床杂志, 2006; 13(1): 55.
17. 周新华, 李宏, 陆才德, 等. 腹腔镜胆囊切除术中预防胆管损伤的经验(附2 694例报告) [J]. 中国普外基础与临床杂志, 2003; 10(5): 499-450.
18. 赖良, 张旭. 腹腔镜胆囊切除术胆管损伤的预防(附8例报告) [J]. 中国普外基础与临床杂志, 2006; 13(4): 394-395.
19. 王俭, 安宁, 郑波, 等. 腹腔镜胆囊切除术中不同类型胆管损伤的处理 [J]. 中国普外基础与临床杂志, 2008; 15(2): 128-129.
20. 张启瑜. 钱礼腹部外科学 [M]. 北京: 人民卫生出版社, 2006: 601.
21. 周永碧, 巫北海. 逆行胰胆管造影发现胆囊管变异的临床意义 [J]. 中华外科杂志， 1990; 28(6): 328-330.
22. 龚建平, 韩本立, 周永碧, 等. 胆囊管异常汇合的诊断及其在腹腔镜胆囊切除术中的意义 [J]. 中国普外基础与临床杂志, 2001; 8(2): 85-87.
23. 李松林, 任作航. 胆囊动脉变异与腹腔镜胆囊切除术 [J]. 腹腔镜外科杂志, 2002; 7(1): 13-14.
24. 崔宏. 解剖变异与医源性胆管损伤关系的临床研究 [J]. 医药论坛杂志, 2003; 24(16): 31-33.　.
25. 袁家天, 吕波, 邹志强, 等. 腹腔镜胆囊切除术胆管损伤的预防 [J]. 华西医学, 2009; 24(5): 1079-1081.
26. 唐振华, 黄建华, 张裕华, 等. 医源性胆管损伤临床分析(附27例报告) [J]. 肝胆外科杂志, 2002; 10(6): 437-439.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Anatomic Factors Associated with Iatrogenic Biliary Injury

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