CAJ | 학술논문

目的探讨医源性胆胰结合部损伤的诊断和外科治疗.方法对我院1998-2010年期间收治的13例医源性胆胰结合部损伤患者的临床资料进行回顾性分析.结果 5例术中发现者,施行裂口修补+胆总管T管引流+腹膜后引流术,术后2例并发切口感染,1例并发十二指肠瘘,均经保守治疗治愈.8例术后发现者,2例患者继发后腹膜脓肿及髂窝脓肿先行脓肿穿刺引流术,后因引流不畅行切开引流;1例合并胰腺、十二指肠损伤者术后出现十二指肠瘘、腹膜后脓肿并大出血再次急诊行清创止血引流+胃空肠吻合加胃窦部可吸收线捆扎术,术后经积极治疗痊愈;2例并发切口感染.所有患者恢复顺利出院.结论早期诊断胆胰肠结合部损伤并及时手术治疗可取得较好效果,应根据损伤的不同程度采用不同的手术方式.
목적 탐토의원성담이결합부손상적진단화외과치료.방법 대아원1998-2010년기간수치적13례의원성담이결합부손상환자적림상자료진행회고성분석.결과 5례술중발현자,시행렬구수보+담총관T관인류+복막후인류술,술후2례병발절구감염,1례병발십이지장루,균경보수치료치유.8례술후발현자,2례환자계발후복막농종급가와농종선행농종천자인류술,후인인류불창행절개인류;1례합병이선、십이지장손상자술후출현십이지장루、복막후농종병대출혈재차급진행청창지혈인류+위공장문합가위두부가흡수선곤찰술,술후경적겁치료전유;2례병발절구감염.소유환자회복순리출원.결론 조기진단담이장결합부손상병급시수술치료가취득교호효과,응근거손상적불동정도채용불동적수술방식.
Objective To explore the measures for diagnosis and surgical treatment of iatrogenic injury in the choledochopancreatico-duodenal junction. Methods The clinical data of 13 patients with choledocho-pancreatico-duodenal junction injury treated in our hospital from 1998 to 2010 were analyzed retrospectively. Results Among the 13 patients, 5 were diagnosed according to the intraoperative findings, cholungiography, and fiber cholangioscopy.All of them were cured after suture of the perforation in the choledochopancreatico-duodenal junction, T-tube drainage, and abdominal drainage.Among the 5 patients, 2 patients developed wound infection, and one got fistula. The other 8 patients were diagnosed after surgery and were cured. Among them, 2 patients developed severe abdominal and retroperitoneal infection after operation, but were cured after multiple drainage procedures and debridement; 1 patient developed severe abdominal and retroperitoneal infection, fistula, and bleeding, but was cured after multiple drainage procedures and debridement; 2 patients developed wound infection. All patients were discharged from hospital after recovery. Conclusions Early diagnosis and treatment of iatrogenic injury in the choledocho-pancreatico-duodenal junction can obtain perfect effect. Different procedures should be performed according to different degrees of the injury. The perfect imaging examination and intraoperative choledochoscopy before bile duct exploration may reduce the occurrence of the injury.