Difficulties and countermeasures of diagnosis and treatment of biliary dilatation

Abstract

The pathogenesis of biliary dilatation is unclear and the preoperative evaluation of pancreaticobiliary junction type is still difficult. The indication of minimally invasive surgery is limited. Diagnosis and treatment of gestational biliary dilatation and reoperation of biliary dilatation are two tricky problems. There are two dilemmas in the treatment of biliary dilatation, including the balance between radical resection of pathological bile ducts and organ reservation, as well as balance between radical resection of pathological bile ducts and surgical safety. The most difficult regions of diagnosis and treatment lie in the hilar dilated bile duct and dilated bile duct in the pancreatic segment. Dong′s classification simplifies the classification of extrahepatic bile duct dilatation and subdivides the classification of intrahepatic bile duct dilatation on the basis of Todani classification. It highlights the difficulties of treatment and provides more accurate basis for choosing appropriate method according to the classification. The therapeutic goals of biliary dilatation are the radical excision of pathological bile duct, removal of the secondary lesions and reconstruction of excellent cholangiojejunostomy. The principle of surgical procedure choice is choosing appropriate method according to the classification. Perihilar surgery technique and pancreatic door plate descending technique can be used to deal with the dilated bile ducts at hilar and pancreatic segment on the basis of accurate evaluation in order to improve the thoroughness and security of pathological bile duct resection. Not only short-term complications such as postoperative bile leakage and pancreatic leakage require management, but radical resection of lesion and long-term life quality of patients should be paid more attention. Key words: Biliary dilatation; Perihilar surgery technique; Dong′s classification; Pancreatic door plate descending technique