临床医学论文-医源性胆胰肠结合部损伤的诊治

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1、临床医学论文•医源性胆胰肠结合部损伤的诊治作者：王坚吴志勇何敏王钦尧施维锦陈涛【摘要】FI的总结医源性胆胰肠结合部损伤的经验教训，以提高其诊疗水平。方法回顾性分析1997年6丿」至2007年6丿」收治的8例胆胰肠结合部损伤患者的诊治情况。结果胆总管末端损伤5例，十二指肠前琏损伤/漏3例。术中发现胆总管末端损伤合并结石嵌顿3例，均行Oddi括约肌切开成形+经壶腹部直视下穿孔修补+胆总管T管外引流术治愈；术后发现5例，1例行十二指肠漏口修补+胃窦部可吸收线缝闭+胆总管下段叮吸收线结扎+胆总管T管外引流+腹腔引流+空肠造痿+胃造痿术治愈；其余4例多次手术，

2、因腹腔感染及反复腹腔出血而死亡。结论术中发现漏口的患者，可直接修补，并行胆总管T管外引流+腹腔引流术;未发现者则行胆总管T管外引流+漏口周围引流术;胆总管末端穿通伤,合并Oddi扌舌约肌狭窄或壶腹部结石嵌顿者，行Oddi括约肌切开，经壶腹直视下修补+胆总管T管外引流+腹腔引流术，合并十二指肠损伤，同时行十二指肠修补术；对丁•首次术屮未发现及术后出现十二指肠漏的患者，应根据其情况行合理的控制性手术，其关键是彻底的胆胰分流、十二指肠憩室化、空肠营养性造痿及有效的腹腔引流。【关键词】胆胰肠结合部；损伤；Oddi括约肌切开成形术；控制性手术[Abstract

3、!ObjectiveTodiscussthediagnosisandappropriateoperationmethodforiatrogenicinjuryincholodochopancreaticoduodenaljunction.MethodsTheclinicaldataof8patientswithiatrogenicinjuryincholodochopancreaticoduodenaljunctionadmittedinourdepartmentfromJune1997toJune2007wereretrospectivelyana

4、lyzed.RcsultsFivepatientswerediagnosedinjuryattheendofcommonbileductandtheother3withinjuryorfistulaintheanteriorwallofduodenum.ThreepatientswerediagnosedinjurycombinedwithstoneimpactionattheendofcommonbileductintraoperativelyandwerecuredafterOddisphincteroplasty,suturingthesmal

5、1holeondistalcommonbileductunderdirectviewviaampullarVaterandTtubedrainageofthecommonbileduct・Fivepatientswithcholodochopancreaticoduodenaljunctioninjurywerediagnosedpostoperativcly,only1survivedafteracceptingduodenalventagerepair,pylorusclosurewithabsorbablesuture,distalcommon

6、bileductligationwithabsorbablethread,Ttubedrainageofthecommonbileduct,abdominaldrainage,jejunostomyfornutritionsupportandgastrostomy,theother4diedaftermultipleoperationsbecauseofintraabdominalinfectionandrepeatedblccding.ConclusionsIfventagesarcdiscoveredduringoperation,promptr

7、epaircombinedwithTtubedrainageofthecommonbileductandabdominaldrainageshouldbeperformed;ifnot,Ttubedrainageofthecommonbileductanddrainageincholodochopancreaticoduodenaljunctionshouldbedone.FortheinjuryattheendofcommonbileductplusOddisphincterstenosisorstoneimpactionwithinampulla

8、rVater,sphincteroplastyandtransampullarperforationmend