胆胰肠结合部医源性损伤的诊治体会(附7例临床报告)  

The diagnosis and treatment of the iatrogenic injury in conjoint part of common bile duct,duodenum and pancreas(with 7 cases clinical report)

作　　者：李春来[1] 毛颖[1] 黄志刚[1] 王浪[1] 

机构地区：[1]贵阳市第一人民医院普外科,贵州贵阳550002

出　　处：《四川医学》2012年第2期239-241,共3页Sichuan Medical Journal

摘　　要：目的探讨胆胰肠结合部医源性损伤的诊断和治疗体会方法。方法回顾分析2002～2009年我院收治7例胆胰肠结合部医源性损伤病例,其中开腹手术4例,EST术3例。结果 7例患者均痊愈出院,开腹手术4例患者均于术中发现胆胰肠结合部损伤,2例行术中胆管破口修补,3例EST术后所致胆胰肠结合部损伤患者,均于术后出现腹痛,腰背部疼痛及发热后,经CT及B超检查发现,2例保守治疗痊愈,1例经腰背部脓肿切开引流及坏死组织清除后痊愈。结论胆胰肠结合部医源性损伤在思想上应高度重视,术中及时发现,合理处理是提高治疗效果的关键,术后严密观察,及时CT及B超检查是提高诊断率的关键,个体化的处理是合理的选择。Objective To discuss the diagnosis and the treatment of the iatrogenic injury in the conjoint part of common bile duct,duodenum and pancreas.Methods Retrospective study was done on 7 cases of the iatrogenic injury in the conjoint part of common bile duct,duodenum and pancreas from 2002 to 2009.In those cases,4 cases injured by laparotomy,and 3 cases injured by Endoscopic Sphincterotomy（EST）.Results 7 cases all completely recovered.In the group of injury by laparotomy,all of them had discovered the injury in the conjoint part of common bile duct,duodenum and pancreas during the operation,and 2 cases prompt sutured the small hole on distal common bile duct.In the group of injury by EST,all of them discovered the injury in the conjoint part of common bile duct,duodenum and pancreas by type-B ultrasonic or CT because of bellyache,pain in the small of back,and heat in the patients postoperatively.2 cases recovered by conservative treatment,the other case recovered by operation of incision and drainage the abscess in the small of back.Conclusion The operation in the conjoint part of common bile duct,duodenum and pancreas may cause to iatrogenic injury,highly value on thought,discovered in time during operation,and reasonable transaction could raise treatment effect.Tight observation postoperatively,checks in time by type-B ultrasonic or CT scan could raise a diagnosis rate,and choose a reasonable treatment of individuation could raise a cure rate.

关 键 词：胆胰肠结合部 胆胰结合部 医源性损伤 

分 类 号：R657.4[医药卫生—外科学]