医源性胆胰肠结合部损伤的预防与处理

PREVENTION AND TREATMENT OF IATROGENIC INJURY IN CSBPD(conjugation site of the common bile duct and the main pancreatic duct and duodenal wall)

目的总结医源性胆胰肠结合部损伤的防治经验.方法病例资料的回顾性分析.我院于1994年1月～2004年12月共发生医源性胆胰肠结合部损伤7例,2例发生在十二指肠乳头括约肌切开后的取石过程中,5例发生在开腹胆道手术中扩张胆总管下段狭窄时.针对损伤实施胰十二指肠切除术2例;胆总管横断型胆总管空肠吻合术5例,其中4例同时加做十二指肠憩室化手术.全部病例均在术中于局部放置双套管引流,术后给予施他宁抑制胰腺分泌.结果6例痊愈;1例死亡.结论在取出结石和扩张狭窄过程中控制好操作力度是防止发生医源性胆胰肠结合部损伤的关键.全胆汁改道和十二指肠憩室化是处理胆胰肠结合部损伤的有效措施,强调全胆汁改道手术和十二指肠憩室化手术同时实施.具体术式推荐横断胆总管型胆管空肠吻合术和胃肠吻合加胃窦部可吸收肠线捆扎术.局部损伤严重时可行胰十二指肠切除术.

Objective To sum up the experience on prevention and treatment of iatrogenie injury in CSBPD. Methods The retrospective analysis was used to study,seven cases who were treated in our hospital from Jan 1994 to Dee 2004. 2 cases occurred in the course of extracting stone after endoscopic sphineterotomy. 5 cases occurred in the course of dilating stenosis in laparo-eholangio-operation. The treatments included panereato-duodeneetomy for 2 patients, eholedoeho- jejunostomy for 5 patients. 4 of them received synchronously duodeno-divertieularization operation. All patients underwent the managements that placed SHUANG-TAO-GUAN Local drainage during the operation and restrained pancreatic enzyme secretion after the operation. Result One patient died. Six cases healed. Conclusion The key that avoided iatrogenie injury in CSBPD was the power that extracted stone and dilated stenosis. Total bile bypass and duodenal divertieularization, which should be performed at the same time, were the effective measures in dealing with iatrogenic injury in CSBPD. Choledoeho- jejunostomy plus eholedoehal transection and gastrojejunostomy plus gastric antrum enlaeement with absorbable catgut could be selected as the concrete operative mode. If the injury was grievous, panereato-duodeneetomy might be necessary.