医源性胆胰肠结合部损伤

Diagnosis and management of iatrogenic choledocho-pancre-atico.duodenal junction injury

胆胰肠结合部解剖位置及组织结构特殊，极易在手术操作中受到损伤并产生严重后果，因此，亟待对医源性胆胰肠结合部损伤进行深入的临床研究。胆胰肠结合部损伤的原因主要包括解剖因素、病理学因素及医源性因素；诊断包括术中诊断及术后延迟诊断；治疗主要包括术中缝合修补、T管引流，术后清创引流、胆胰分流、十二指肠憩室化、空肠造瘘及胃肠道和胆道重建；术中的精细操作，手术末预防性行T管注水、T管造影、胆道镜等检查可有效预防医源性胆胰肠结合部损伤。有效的预防及早期合理的损伤控制外科治疗，可降低医源性胆胰肠结合部损伤的发生率及病死率。

The anatomy and position of choledochopancreaticoduodenal junction are unique, so choledochopancreaticoduodenal junction is easily be injured during operation, and thus it needs further investigation. Anatomical, pathological and iatrogenic factors are the 3 main causes of choledochopancreaticoduodenal junction injury. The diagnosis of choledochopancreaticoduodenal junction injury includes intraoperative and postoperative diagnosis; and the treatment methods include intraoperative repaire and suture, T tube drainage, postoperative debridement and drainage, biliopancreatic shunt, duodenal diverticulum, jejunum stoma, gastrointestinal and biliary reconstruction. Precise operation, T tube cholangiography, choledochoscopy can effectively prevent the choledochopancreaticoduodenal junction injury. The principle of early discovery, early management, avoiding overmanagement, and promoting damage control surgery should be awared to reduce the mortality.