胆道术中十二指肠误伤及紧急处理7例分析

Analysis of 7 cases about accidental injury of duodenum and emergency treatment during operation of biliary tract

目的探讨胆道手术中所致十二指肠误伤后紧急处理的要点和应该吸取的教训.方法顾性分析我院普外科1995年7月至2005年7月所遇到的7例胆道术中十二指肠误伤及紧急处理的病例资料.其中:4例系在使用Baker 's探条进行探查胆道时致十二指肠后壁损伤;3例因分离十二指肠与腹腔广泛粘连时所致十二指肠前壁损伤.术中紧急处理方法:根据每位患者的不同情况,分别采用损伤修补、十二指肠腔内外引流和胃空肠造瘘术.结果全组治愈5例,死亡2例;远期结果:随访1～10年,治愈的5例患者均健在.结论胆道术中所致十二指肠误伤的并发症主要在于预防;误伤发生后,手术者应做到及时发现并根据患者当时的具体病情情况,合理选择有效的紧急处理方法是成功治疗此类患者的关键.

Aim To inquire into the main point on accidental injury, of duodenum and emergency treatment and to have to draw a lesson during operation of biliary. Methods To review the cases of our general surgical department that 7 patients suffered from accidental injury of duodenum during operation of biliary from July 1995 to July 2005, there were 4 patients of accidental injury of back part of duodenum by using Baker`s probe and there were other 3 patients of injury of front part of duodenum because of separating duodenum from extensive adhere of abdominal cavity. At that time, the emergency treatments which conclude repair of injury, duodenal inner or outer drainage and making fistula of stomach or jejunum should be separately given to those patients according to different situation of patients. Resuits The results of short term ： among all 7 cases,5 patients were cured and 2 patients were dead at the same time. The results of long term： according to postoperative followsup from 1 to 10 years,all 5 patients who were cured are alive in good health. Conclusion The complication of accidental injury of duodenum during operation of biliary depends on precaution mainly. After accidental injury taking place, it is a key of curing those patients successfully that the operational doctor should find out the complication in time and select out a effective, reasonable method of emergency treatment.