医源性胆胰肠结合部损伤的诊治与预防  

Diagnosis,treatment and prevention of iatrogenic injury in choledochopancreaticoduodenal junction

作　　者：曹钧[1] 卢绮萍[1] 

机构地区：[1]广州军区武汉总医院普通外科,武汉430070

出　　处：《腹部外科》2015年第4期266-269,共4页Journal of Abdominal Surgery

摘　　要：目的：探讨医源性胆胰肠结合部损伤的诊断、处置方法和预防要点。方法回顾性分析1996年1月至2014年12月间收治的13例医源性胆胰肠结合部损伤病人的临床资料。术中11例均发现注水试验阳性，胆道镜检查证实损伤。术中发现病例依损伤部位采用胆管修补、T管引流或加行 Oddi 括约肌成形术；延迟发现2例，行胆胰完全分流、十二指肠完全憩室化、空肠造瘘，半年后行消化道及胆道重建。结果13例手术均顺利完成。术后1例出现十二指肠瘘并严重腹腔感染，再次手术后发生腹腔大出血死亡；12例术后恢复顺利，随访时间2～18年，疗效满意。结论术中注水实验阳性及胆道镜检查均可有效诊断胆胰肠结合部损伤，及时的诊断和手术处理可防止严重并发症的发生；延迟发现病例手术处置需遵循损伤控制要求。预防损伤尤为重要。Objective To explore the diagnosis,treatment and prevention of iatrogenic injury in choledochopancreaticoduodenal junction.Methods The clinical data of 13 cases of iatrogenic injury in choledochopancreaticoduodenal junction from January 1996 to December 2014 were retrospectively analyzed.And 1 1 cases were detected intraoperatively by water injection test and confirmed by choledo-choscopy.And bile duct repair and suturing plus T tube drainage or sphincteroplasty of Oddi were completed according to injury site.Complete biliopancreatic shunt,duodenal diverticulum and jejunum stoma were performed in 2 misdiagnosed cases and followed by gastrointestinal and biliary reconstruction after 6 months.Results All operations were completed successfully.One cases of duodenal fistula with severe infection died postoperatively from massive hemorrhage.And the remainder recovered smoothly.Satisfactory efficacies were confirmed during a follow-up period of 2-1 8 years.Conclusions Water injection test and choledochoscopy can effectively detect the injury in choledochopancreati-coduodenal junction during operation.Early diagnosis and surgical intervention may prevent the occur-rences of severe postoperative applications.Damage control procedures are necessary for misdiagnosed cases.And preventing iatrogenic choledochopancreaticoduodenal injury is essential.

关 键 词：胆胰肠结合部 医源性损伤 诊断 治疗 预防 

分 类 号：R657.4[医药卫生—外科学]