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ID:15143042
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页数:11页
时间:2018-08-01
《医源性胆胰肠结合部损伤的诊治》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、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】目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月至2007年6月收治的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,十二指肠前壁损伤/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+胆总管下段可吸收线结扎+胆总管T管外引流+腹腔引流+空肠造瘘+胃
2、造瘘术治愈;其余4例多次手术,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括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;对于首次术中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、空肠营养性造瘘及有效的腹腔引流。【关键词
3、】胆胰肠结合部;损伤;Oddi括约肌切开成形术;11控制性手术【Abstract】ObjectiveTodiscussthediagnosisandappropriateoperationmethodforiatrogenicinjuryincholodochopancreaticoduodenaljunction.MethodsTheclinicaldataof8patientswithiatrogenicinjuryincholodochopancreaticoduodenaljuncti
4、onadmittedinourdepartmentfromJune1997toJune2007wereretrospectivelyanalyzed.ResultsFivepatientswerediagnosedinjuryattheendofcommonbileductandtheother3withinjuryorfistulaintheanteriorwallofduodenum.Threepatientswerediagnosedinjurycombinedwithstoneimpactio
5、nattheendofcommonbileductintraoperativelyandwerecuredafterOddisphincteroplasty,suturingthesmallholeondistalcommonbileductunderdirectviewviaampullarVaterandTtubedrainageofthecommonbileduct.Fivepatientswithcholodochopancreaticoduodenaljunctioninjurywer
6、ediagnosedpostoperatively,only1survivedafteracceptingduodenalventagerepair,pylorusclosurewithabsorbablesuture,distalcommonbileductligationwithabsorbablethread,Ttubedrainageofthecommonbileduct,abdominaldrainage,jejunostomyfornutritionsupportandgastrosto
7、my,theother4diedaftermultipleoperationsbecauseofintraabdominal11infectionandrepeatedbleeding.ConclusionsIfventagesarediscoveredduringoperation,promptrepaircombinedwithTtubedrainageofthecommonbileductandabdominaldrainageshouldbeperformed;ifnot,Ttubedr
8、ainageofthecommonbileductanddrainageincholodochopancreaticoduodenaljunctionshouldbedone.FortheinjuryattheendofcommonbileductplusOddisphincterstenosisorstoneimpactionwithinampullarVater,sphincteroplastyandtransampullarperforatio
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