Oddi括约肌切开成形术中胆胰肠结合部医源性损伤的预防与处理  

Prevention and treatment of iatrogenic injuries in choledocho-pancreatico-duodenal junction in Oddi sphincteroplasty

作　　者：梁力建[1] 陈伟[1] 

机构地区：[1]中山大学附属第一医院肝胆外科,广东广州510080

出　　处：《中国实用外科杂志》2013年第5期370-372,共3页Chinese Journal of Practical Surgery

摘　　要：开腹Oddi括约肌切开成形术仍是临床上常用的手术方法,在狭小的手术野中进行细致的手术容易招致医源性的损伤。发生损伤原因包括解剖因素、病理因素和手术操作因素。并发症主要包括胆管和胰腺的穿通伤、胰管阻塞引起的胰腺炎、十二指肠漏、消化道出血等。严重的损伤导致各种并发症发生,甚至威胁病人生命。因此,术中应充分游离十二指肠降段,正确辨认和寻找乳头、避免暴力的探查,选择合适的缝线细致吻合胆管及十二指肠黏膜,牢靠关闭十二指肠切口。一旦出现损伤后的并发症,应遵循先处理急症,然后逐步寻找部位和病因,再针对病因进行合理的处理。Operative sphincteroplasty remains a common sur- gical procedure in clinical practice. The narrow operating field often leads to iatrogenic injury. The causes of iatrogenic injury include various facto such as anatomic, pathologic and surgical factors. Complications mainly include penetrating injury of bile duct and pancreas, acute pancreatitis caused by pancreat- ic duct obstruction, duodenal leakage, gastrointestinal hemor- rhage and so on. Severe injury can lead to multiple complica- tions and might be life-threatening. For the prevention of iatro- genic injury, it should adopt a series of measures including dis- sociating the descending part of the duodenal fully, identifying the duodenal papilla correctly, avoiding violent exploration, choosing the appropriate suture, anastomosing bile duct and duodenal mucosa carefully, closing the duodenal incision securely. Once complication occurred, it should manage the most urgent situation, and then find out the location and causes of the disease followed by proper management according to the etiology.

关 键 词：ODDI括约肌切开成形术 胆胰肠结合部 医源 性损伤 

分 类 号：R6[医药卫生—外科学]