胆道手术中十二指肠损伤的预防及治疗

目的探讨胆道手术中十二指肠损伤的防范及处理收集我院自1995年～2004年遇到的7例十二指肠损伤病人作回顾性的临床分析。结果本组5例系在探条探查胆道时致十二指肠后壁损伤；2例因分离十二指肠与肝胆广泛粘连而损伤；2例因分离十二指肠与肝肠广泛粘连而损伤十二指肠前壁，其中1例致十二指肠广泛撕裂合并门静脉主干破裂出血，另2例为邻近炎症病变致十二指肠延迟性穿孔。处理方法分别用损伤修补、十二指肠腔内外引流和胃空肠造瘘术。全组治愈6例，死亡1例。结论胆道手术中十二指肠损伤防范是主要的，而合理、灵活地选择恰当的处置方法乃治疗是成功的关键。胆道手术中十二指肠损伤是一种严重的医源性创伤，一旦发生，倍感棘手，处理得当与否，直接影响到原来手术的结果。本文7例损伤病例，并就其防范及处理进行探讨。

Objective A clinical analysis is conducted based on review and discussion of 7 cases of duodenal injury inbiliary tracts surgery,which were collected from 1995-2004 in our hospital. Results, 3cases were injuries in duodenal posterior wall caused by backer＇s probe during ascertainment; 2 cases were caused by separation of the infective adherence between the duodenum and hepatobiliary position; 2cases were injuries in duodenal anterior wall caused by separation of the infective adherence between the duodenum and hepatobiliary position, one of the cases occurred great duodenal avulsion with concomitance portal hemorrhage;the rest 2 cases were delayed perforation of duodenal wall due to affected from adjacent bibiary infection. These cases were treated, respectively, with repair of duodenal injury,placed the drainage tube in intro-or extra-duodenaum and gastrojejunostomy.In the group of 7 cases, 6 were cured and 1 died. Conclusion, it is very important to take precaution of duodenal injury in biliary tracts surgery. An appropriate choice of reasonable and flexible therapeutic disposal is the key to successful treatment.Duodenal injury in biliary tracts surgery is a severe iatrogenic trauma and clinically very intractable. The inappropriate disposal has direct effect on the result of treatment. In our review of the 7 cases of injuries, we discussed in detail about the precaution and disposal in such situations.