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[Abstract] analyzed retrospectively 15 cases of endoscopic treatment of bile leakage after biliary tract surgery in patients with clinical data. 15 cases of biliary fistula cured, were followed up for 6 to 12 months, no recurrence of biliary fistula. Endoscopic treatment of biliary fistula is safe, more effective, less invasive and less complications. Most patients with biliary fistula as the preferred treatment.Hepatobiliary Surgery biliary fistula is common complications after surgery, surgical treatment is currently used in the clinic again. This retrospective analysis of December 2005 ~ October 2008 our hospital endoscopic treatment of bile leakage after biliary tract surgery, 15 cases are reported below.The group of 15 patients, 6 males and 9 females. Aged 35 to 72 years, mean (57.0 4.2) years. Laparoscopic cholecystectomy (LC) 11 cases, open cholecystectomy (OC) 2 cases, open cholecystectomy combined biliary duct exploration in 2 patients. 15 cases, 11 cases of abdominal pain, fever in 9 cases, 4 cases of jaundice. 15 cases 1 ~ 7d, through the B-, CT examination in 15 cases, magnetic resonance imaging cholangiopancreatography (MRCP) examination of 7 cases, retrograde cholangiopancreatography (ERCP) examination, 15 cases confirmed to be biliary fistula.
1.2 Diagnostic criteria
B-, CT and MRCP diagnosis of biliary fistula criteria: bile duct postoperative fluid accumulation around the inner road, peritoneal drainage tube suction tube or abdominal puncture the


bile-like liquid, bilirubin increased significantly. ERCP diagnosis of biliary fistula criteria: contrast agent outside the overflow to the bile duct, the bile duct to drain spill at the mouth. Removal of nasal biliary drainage (ENBD) tube indications: After ENBD tube cholangiography, no bile leak out, the lien after 2 ~ 3d ENBD tube removed.
1.3 Methods
First line of ERCP, further clarify the diagnosis of biliary fistula and bile duct injury location, nature and extent of further duodenal sphincterotomy (EST) and ENBD, if the bile duct stricture of biliary stent implantation. At the same time abdominal cavity drainage, somatostatin, and recombinant human growth hormone and other drugs treatment.Biliary fistula in 15 cases, simple lines EST and ENBD 7 , ENBD tube placement for 2 to 5.5 weeks. Bank EST biliary stenting combined 8 patients, stent placement for 3 to 6 months. Hospital 7 ~ 42d, the average (16.0 5.5) d, were cured. 15 cases were followed up for 6 to 12 months, the average (9.0 1.2) months, no recurrence of biliary fistula, no postoperative bile duct stricture.Biliary fistula often lead to bile duct injury due to surgery due to failure, often accompanied by bile duct stricture. LC is mainly due to biliary fistula titanium clip off the cystic duct stump or incomplete occlusion; Vice bile duct or bile duct injury vagus; common bile duct transection or laceration; extrahepatic bile duct causes thermal burns coagulation secondary to extrahepatic bile duct stenosis and delayed tissue necrosis, loss perforation, biliary fistula caused by [1]. Lower bile duct pressure, bile drainage is the key to treatment of biliary fistula. Line using the endoscopic EST, the bile excretion of smooth, reducing duct pressure; again ENBD, will have more than one side hole placed in front of the nasal duct leakage or over the mouth and continued to liposuction to reduce the outflow of bile from the drain port can also reduce the concentration of bile ducts outside, which is good because ENBD siphonage effect [2]. If the common bile duct injury caused biliary fistula, missed the mouth of the larger biliary plastic stent placement may be F8.5, F10, F12, adequate drainage, drain the mouth in order to facilitate the repair and healing, 2 to 4 weeks after drainage, drain the mouth can be self- healing. 8 patients in this group biliary stent, the fistula healed in 2 to 4 weeks, 36 months later, 7 patients without bile duct stricture after stent removal. 1 case of right hepatic duct stenosis with stones, once again into a single frame, narrow lifted. Bile duct stricture should be clear if the location and extent of stenosis, if the intrahepatic bile duct stenosis, bile duct stricture possible dilatation balloon catheter, and then the line ENBD or bile duct stenting; if extrahepatic bile duct stricture should be carefully use of balloon catheter dilatation, especially early bile duct injury should be retained long ENBD tube, bile duct inflammation is subject to disappear, select the period of implementation of the bile duct stenting. Stent placed 3 to 6 months is appropriate, to prevent biliary tract infection. Zhang Rui [3] reported 120 cases of patients with stent implantation and found that most patients in the biliary stent placement after a few days to several weeks of jaundice subsided quickly, significantly decreased serum bilirubin levels, liver function gradually restored, 120 patients were followed up 3 to 36 months, the average rate of stents was 80% open, so that the stent for benign biliary stricture has obvious therapeutic effect. Subject only to conventional endoscopic pharyngeal anesthesia without laparotomy, a small disturbance on the body, the short preparation time before surgery, once the success of endoscopic therapy, drainage effective, quick, play inside and outside the drainage effect. This article only appears biliary fistula and biliary stenosis treatment of iatrogenic bile duct injury to explore fully the environmental treatment of common bile duct transection, has its limitations, the incidence of biliary stricture forward for further observation.[1] BA Ming Chen, Mao Jingxi, Chen Xun, et al. Laparoscopic cholecystectomy bile leakage and the countermeasures. Journal of General Surgery, 2004,19 (1) :77-7 [2] Zhang Xiao, Zhang Xiaofeng, LI Kwok Hung, et al. Endoscopic treatment of biliary leakage and secondary biliary strictures. Journal of Gastroenterology, 2005,22 (1) :14-1 [3] Zhang Rui. Benign biliary stricture of the metal stent and its progress. Inner Mongolia Medical College, 2002,24 (4) :286-289.


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