腹部外科
腹部外科
복부외과
JOURNAL OF ABDOMINAL SURGERY
2015年
4期
266-269
,共4页
胆胰肠结合部%医源性损伤%诊断%治疗%预防
膽胰腸結閤部%醫源性損傷%診斷%治療%預防
담이장결합부%의원성손상%진단%치료%예방
Choledochopancreaticoduodenal junction%Iatrogenic injury%Diagnosis%Treatment%Prevention
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。
目的：探討醫源性膽胰腸結閤部損傷的診斷、處置方法和預防要點。方法迴顧性分析1996年1月至2014年12月間收治的13例醫源性膽胰腸結閤部損傷病人的臨床資料。術中11例均髮現註水試驗暘性，膽道鏡檢查證實損傷。術中髮現病例依損傷部位採用膽管脩補、T 管引流或加行 Oddi 括約肌成形術；延遲髮現2例，行膽胰完全分流、十二指腸完全憩室化、空腸造瘺，半年後行消化道及膽道重建。結果13例手術均順利完成。術後1例齣現十二指腸瘺併嚴重腹腔感染，再次手術後髮生腹腔大齣血死亡；12例術後恢複順利，隨訪時間2~18年，療效滿意。結論術中註水實驗暘性及膽道鏡檢查均可有效診斷膽胰腸結閤部損傷，及時的診斷和手術處理可防止嚴重併髮癥的髮生；延遲髮現病例手術處置需遵循損傷控製要求。預防損傷尤為重要。
목적：탐토의원성담이장결합부손상적진단、처치방법화예방요점。방법회고성분석1996년1월지2014년12월간수치적13례의원성담이장결합부손상병인적림상자료。술중11례균발현주수시험양성，담도경검사증실손상。술중발현병례의손상부위채용담관수보、T 관인류혹가행 Oddi 괄약기성형술；연지발현2례，행담이완전분류、십이지장완전게실화、공장조루，반년후행소화도급담도중건。결과13례수술균순리완성。술후1례출현십이지장루병엄중복강감염，재차수술후발생복강대출혈사망；12례술후회복순리，수방시간2~18년，료효만의。결론술중주수실험양성급담도경검사균가유효진단담이장결합부손상，급시적진단화수술처리가방지엄중병발증적발생；연지발현병례수술처치수준순손상공제요구。예방손상우위중요。
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 ana-lyzed.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 reconstruc-tion after 6 months.Results All operations were completed successfully.One cases of duodenal fistu-la 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.
