Bile duct stenosis

　　Bile duct stenosis is caused by scar contracture of the bile duct lumen due to bile duct injury and recurrent cholangitis, or it may be congenital. The general causes of this disease include the following three points:

　　1. Disease factors

　　Bile duct stenosis can be caused by some bile duct diseases, such as cholecystitis, cholelithiasis, bile duct stones, or parasitic diseases, which lead to inflammation in the intraductal lumen. Recurrent inflammation causes the fibrous tissue in the bile duct wall to proliferate and thicken, leading to inward expansion.

　　2. Surgical factors

　　During some bile duct disease surgeries, gallbladder resection surgery can lead to direct or indirect bile duct injury, which is the most common cause of bile duct stenosis, accounting for 90% of the causes of bile duct stenosis. This includes operations such as liver transplantation and liver resection, which can cause bile duct injury and lead to bile duct stenosis.

　　3. Genetic factors

　　Individuals may have bile duct stenosis due to genetic diseases inherited from their ancestors, which triggers the disease of bile duct stenosis.

　　Bile duct stenosis can lead to obstructed bile excretion, increased intraductal pressure, and bile stasis. It may also lead to complications such as bile duct stones, cholangitis, Gram-negative enteric bacterial infections, and others. Prolonged and recurrent episodes can eventually worsen the damage to the gallbladder and liver cells, leading to gallbladder necrosis or liver cirrhosis, and in severe cases, it can lead to serious diseases such as gallbladder cancer or liver cancer.

　　To prevent the occurrence of bile duct stenosis, medical staff should strictly follow operational routines in medical work, reduce iatrogenic injuries, develop good living habits, avoid abdominal trauma, actively treat gallstones, infections, and other primary diseases.

　　Bile duct stenosis can manifest as fibrous tissue proliferation in the bile duct wall, thickening of the wall, and gradual narrowing of the lumen. This disease generally requires the following examinations:

　　1. General examination

　　There is an increase in the number of white blood cells and neutrophils, showing obstructive jaundice; severe liver function damage, with an inverted white and globulin ratio; blood culture may be positive.

　　2. Retrograde cholangiography

　　It can display the location, shape, and extent of the stenosis. Bile ducts are not visible, which does not exclude bile duct stenosis. Sometimes, intravenous cholangiography can also show the affected bile ducts.

　　3. B-ultrasound

　　It can display sonograms of bile duct dilatation near the stenosis, or (and) stones.

　　Reasonable diet is the key to disease recovery. So, for patients with bile duct stenosis, how should they eat? The following will give you a detailed introduction, and patient friends should pay attention.

　　1. Minimize the intake of fat, especially animal fat, and avoid eating fatty meat and fried foods. As much as possible, use vegetable oil instead of animal oil.

　　2. A considerable number of gallbladder inflammation and cholelithiasis are indeed related to high cholesterol levels and metabolic disorders in the body. Therefore, it is necessary to limit the intake of high-cholesterol foods such as fish roe, yolks of various eggs, and the livers, kidneys, hearts, and brains of various carnivorous animals.

　　3. It is best to cook food by steaming, boiling, stewing, or braising, and avoid eating a large amount of fried, baked, roasted, smoked, or salted food.

　　4. Increase the intake of foods rich in high-quality protein and carbohydrates such as fish, lean meat, dairy products, fresh vegetables, and fruits to ensure heat supply, thereby promoting the formation of glycogen in the liver and protecting the liver.

　　5. Consume more foods rich in vitamin A such as tomatoes, corn, and carrots to maintain the integrity of gallbladder epithelial cells, prevent the shedding of epithelial cells to form the core of stones, and thus avoid the formation of stones or increase their size and number.

　　6. If possible, drink more fresh vegetable or fruit juices such as watermelon juice, orange juice, and carrot juice regularly. Also, increase the frequency and quantity of drinking water and eating to enhance the secretion and excretion of bile, alleviate inflammation, and prevent bile stasis.

　　7. Eat less food rich in vitamins to avoid increased peristalsis of the gastrointestinal tract due to indigestion, which may trigger biliary colic.

　　8, Quit smoking and drinking and eat less spicy and irritating foods, such as strong seasonings, such as mustard oil, etc., to avoid stimulating the gastrointestinal tract and triggering or aggravating the condition.

　　9, It is advisable to eat light, easy to digest, low residue, temperature-appropriate, non-irritating, low-fat liquid or semi-liquid food, and never let go of your hands and feet for a moment's pleasure, eat and drink to avoid unnecessary troubles, and even trigger bile duct bleeding and endanger life. Therefore, we must pay special attention to dietary health.

　　Bile duct stenosis can lead to obstructed bile excretion, increased bile duct pressure, and bile stasis. Long-term stasis can lead to secondary bile duct stones, cholangitis, Gram-negative intestinal bacterial infections, and other harmful effects. So how should we treat this disease? Below, we will introduce it to everyone:

　　For early fresh bile duct injuries, the narrowed segment is not long, an end-to-end anastomosis can be performed, supported and drained for more than 1 year, but the long-term effect is often not satisfactory. If it is not possible to perform an end-to-end anastomosis, under the condition allowed, various types of bile-enteric anastomosis can be performed, but the Roux-Y anastomosis of bile duct and jejunal loop is most commonly used,

　　For late-stage patients with traumatic stenosis or primary bile duct stenosis caused by bile duct inflammation, bile-enteric anastomosis can also be performed to relieve bile duct obstruction (see bile duct stones and cholangitis).

　　For stenosis at the hilum of the liver, especially for bilateral bile duct orifices stenosis, the hilum should be dissected, and the bile duct above 2 cm from the stenosis should be exposed, or partial resection of the liver quadrilateral lobe should be performed to expose it. When cutting, it should cross the upper and lower ends of the stenosis, and整形 may be necessary if necessary, to enlarge the bile duct lumen, and even it may be necessary to cut the common bile duct, left or (and) right bile duct, and anastomose them with the Y-shaped jejunal side-to-side or end-to-side, requiring as clean as possible to remove the stones in the proximal bile duct, just to improve the surgical effect, etc.

　　For patients with extrahepatic bile duct stenosis, it can also be repaired with vascularized free jejunal or gastric slices.

　　When the primary bile duct stenosis is localized, severe liver lesions can be performed, and liver partial resection can be performed. It is often the resection of the left lateral lobe of the liver.

　　When there are multiple lesions with stones, severe damage to the liver substance, and it is impossible to achieve the purpose with simple bile-enteric anastomosis, the above combined surgery needs to be adopted.

　　When it is impossible to perform certain repairs in a few cases, the narrowed segment can be supported and fixed for a long time with an U-shaped tube. Or use various balloon catheters to dilate the narrowed bile duct. Etc., the above methods should be selected according to the patient's own condition.