胆胰十二指肠结合部复杂病变的处理  

Management of benign complex morbid change in choledocho-pancreatico-duodenal junction

作　　者：雷正明[1] 付文广[1] 温剑[1] 

机构地区：[1]泸州医学院附属医院肝胆外科,四川泸州646000

出　　处：《泸州医学院学报》2014年第1期99-102,131,共4页Journal of Luzhou Medical College

摘　　要：目的：探讨胆胰十二指肠结合部复杂病变的临床特点及处理。方法：对我科1995年6月至2012年6月收治的42例胆胰十二指肠结合部复杂病变进行回顾复习，讨论其诊断、分类、治疗和结果及经验。结果：胰头十二指肠良性病变24例，医源性损伤15例，外伤3例。采取局部修补11例，胰腺-十二指肠-空肠吻合17例（夹心饼式胰腺前、后方双胰肠吻合术3例），括约肌切开6例，胰腺空肠吻合5例，胰十二指肠切除1例，术中未发现2例医源性损伤，仅置引流治疗。医源性损伤术中未发现，术后发生胆漏感染、胰腺炎各1例；术后发生十二指肠漏、腹膜后脓肿1例；全部治愈出院。术后随访6月~9年，全组生活质量优良。结论：对胆胰十二指肠结合部良性病变/损伤采取修补、吻合术式，可取得保留重要结构功能的效果。Objective：To investigate the diagnosis,clinical characteristics,and surgical method of benign complex morbid change in choledocho-pancreatico-duodenal junction. Methods： 42 cases of benign complexs lesion in choledocho -pancreatico -duadenal junction admitted from June 1995 to June 2012 in our department were retrospectively analyzed. The diagnosis,classification ,surgical treatment and results were discussed.The experiences were summed up. Results：There were sixteen patients with diverticulum of duodenal ampulla combined with stone impaction at the end of common bile duct,five with benign tumour, three with deep pancreatic cysts,fifteen with iatrogenic injury and three with trauma in cholodocho-pancreatico-duodenal junction. Eleven cases accepted duodenal or bile duct ventage or pancreatic rift repair with absorbable suture, fourteen with pancreatico-duodeno-jejunum anastomosis, three with anterior and postenrior pancreatic jejunum sandwich anastomosis,six with sphincteroplasty and transampullar perforation mending combined with T tube drainage of the common bile duct and abdominal drainage was also done and five with pancreatic jejunum anastomosis, one with pancreaticoduodenectomy. Three patients occurred postoperative complications：one with duodenal leakage and retroperitoneal abscess, two patients whose injuries in cholodocho pancreatico duodenal junction were not discovered intraoperatively, one had bile fistula and infection postoperatively, another had acute pancreatitis. All of 42 patients were cured. They were follow-up for 6 months to 9 years, all of them had good quality of life. Conclusions：Various repairing or anastomotic operations on benign complex morbid change in cholodocho-pancreatico-duodenal junction can reserve the organ structure and function and diminution injurey.

关 键 词：胆胰管结合部 良性复杂病变 诊断 治疗 

分 类 号：R2-031[医药卫生—中西医结合]