Clinical analysis of patients with iatrogenic bile duct injury.
BACKGROUND
The main cause of iatrogenic bile duct injury is misidentification of the common bile duct as the cystic duct. In this article, we summarize the experience in the treatment of 112 patients with iatrogenic bile duct injury.


METHODS
Clinical data of these patients treated at 10 hospitals of Songhua river area, Heilongjiang province, China from January 1978 to January 2005 were analyzed retrospectively.


RESULTS
In 55.4% patients (62/112), iatrogenic bile duct injury was due to misidentification of the anatomy of Calot's triangle before cholecystectomy. Their diagnosis was based on clinical features, celiac puncture and imaging examination in which ultrasonography was most sensitive, giving a diagnostic rate of 97.5%. Six types of injury were identified according to their locations, and type III damage was commonly seen (92/112). The curative rate in this group was 95.5% (107/112). Eighty-seven patients (77.7%) underwent Roux-en-Y choledochojejunostomy with a cure rate of 94.3% (82/87).


CONCLUSIONS
The prevention of iatrogenic bile duct injury lies in identifying the topography of extrahepatic bile ducts. Roux-en-Y choledochojejunostomy is usually the treatment of choice.
Yang
Wei-Liang
WL
Department of General Surgery, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China. wlyang_2008@163.com
Zhang
Dong-Wei
DW
Zhang
Xin-Chen
XC
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery*; D001652:Bile Ducts / Q000293:injuries*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome