Prevention and treatment of hypersensitivity reactions in the gallbladder due to benign bile duct strictures

Hypersensitivity reactions of the gallbladder, i.e. gallbladder motility disorders, are caused by: disturbances in the neural network within the gallbladder wall; hypersensitivity reactions of the gallbladder; and early stages of gallbladder inflammation. Biliary tract dyskinesissyndrome includes biliary tract dysmotility (dyskinesis, abnormal biliary emptying rate), biliary tract dystonia (abnormal biliary muscle tone) and biliary tract ataxia (impaired coordination between biliary tract components). The clinical manifestations of this disease, which is mostly seen in women, are very similar to those of gallbladder stones and mainly present as abdominal pain in the form of paroxysmal colic in the upper or right upper abdomen. Prevention and treatment of hypersensitivity reactions of the gallbladder caused by benign bile duct stenosis: health care workers should strictly follow the operation routine to reduce the occurrence of medically induced injuries in medical work;. Develop good living habits to avoid abdominal trauma; actively treat primary diseases such as bile duct stone infection. The consequences of bile duct injury are serious, so it is important to prevent its occurrence. In fact, the majority of bile duct injuries of medical origin can be prevented, the operator should focus on the operation, the operation should be carefully and meticulously, and follow certain routine steps, such as in the implementation of cholecystectomy, first reveal the common bile duct, common hepatic duct and cystic duct, identify the relationship between the three and then use a silk wire to cover the cystic duct, not to cut it off. Then retrograde separation of the gallbladder is done from the bottom of the gallbladder to the point where the cystic duct converges into the common bile duct, and only then is the cystic duct ligated and cut. If the relationship between the above three ducts is not clear when separating the cystic duct, a choledochotomy can be considered and a probe rod can be placed to help determine the position of each bile duct. Intraoperative cholangiography can also be used to help locate the ducts. In addition, the gallbladder should be sheared as close to the wall as possible when separating the gallbladder, and bleeding should be carefully stopped in case of bleeding, avoiding large sutures to stop bleeding, and always be alert to the presence of bile duct malformations. With the accumulation of treatment experience and lessons learned, the concept of “prevention is important” is being advocated by more and more surgeons. In upper abdominal surgery, carelessness is the first aspect of biliary injury, and Landibous believes that 2/3 of biliary injuries are caused by experienced surgeons. Anatomic variation is a major cause of intraoperative biliary tract injury. Of course, the inexperience of a significant number of surgeons is another important reason. Currently, trans-laparoscopic cholecystectomy has become the procedure of choice for gallbladder removal. And after the introduction of trans-laparoscopic cholecystectomy, there is an increasing trend of medically induced biliary tract injuries. Indeed, there is a learning process for mastering this procedure, but it should not be at the expense of patient suffering. There has been a lot of literature on how to prevent biliary injury intraoperatively, both nationally and internationally. It is worth mentioning that some modern major hospitals in China are already implementing a system of admission of physicians for surgical qualification. For example, Peking Union Medical College Hospital has clearly defined the qualifications for trans-laparoscopic cholecystectomy, including the level of the surgeon, the number of previous open cholecystectomy cases, the number of previous one-assist trans-laparoscopic cholecystectomy cases, and so on. The fundamental purpose of the physician surgical qualification admission system is to eliminate the occurrence of medically induced injuries at the source, and should be vigorously promoted nationwide.