Postoperative anastomotic bile duct stricture is affected by the experience of surgeons and the choice of surgical procedures but not the timing of repair after obstructive bile duct injury

摘要

Bile duct injury (BDI) is one of the most severe complications of biliary operation. This study is to investigate the correlation between the timing of bile duct repair and anastomotic bile duct stricture. Transverse BDI models were constructed in 60 dogs that were divided randomly into BDIsub5/sub, BDIsub10/sub, BDIsub15/sub, BDIsub20/sub, and BDIsub30/sub groups according to days of injury (5, 10, 15, 20, and 30 days). The morphological and histological changes of anastomotic stoma of hepaticojejunostomy (HJ) were observed after bile duct reconstruction. TGF-β1, α-SMA, and collagen of anastomotic stoma were detected. After HJ, the concentration of direct bilirubin decreased significantly, dropping to 50% after one week, and returning to normal levels after three weeks. The anastomotic diameter shrunk from 1.5 cm to 0.6 cm without significant difference. At 3 months and 6 months after HJ, the expression of TGF-β in the anastomotic tissue in BDIsub5/sub group was higher than that in BDIsub10/sub, BDIsub15/sub, BDIsub20/sub, and BDIsub30/sub groups. However, no significant differences were observed (F = 1.282, emP/em > 0.05 at 3 months; F = 1.308, emP/em > 0.05 at 6 months). Similarly, the expression of α-SMA and collagen did not vary significantly. For obstructive BDI, repairing time is not a relevant factor for postoperative anastomotic stenosis, but surgeons and operation methods are the key factors. For patients with BDI, hospitals should focus on the experience of surgeons and the choice of operation methods in order to achieve a good long-term effect.