损伤控制理念用于胆总管下段医源性损伤治疗临床意义

Damage control surgery in treatment for iatrogenic injury of the distal common bile duct

医源性胆总管下段损伤存在一定的特殊性。由于其解剖位置较隐匿,常不能在术中及时发现,一旦延误诊断,将产生类似急性坏死性胰腺炎的病理生理进程,处理困难。如果术中发现胆总管下段损伤,手术原则为尽量修补破口,同时行胆管T管外引流和有效的后腹膜引流。延迟发现的胆管损伤,应采用损伤控制的理念,行胆胰分流、十二指肠憩室化、后腹膜引流和空肠造口,半年后行确定性手术。

It is difficult to find and treat iatrogenic injury of the distal common bile duct intraoperatively because of the unobvious anatomical location. Once the diagnosis is delayed, the pathophysiological course like acute necrotic pancreatitis may occur and is difficult to manage. If the rupture can be discovered during operation, prompt repair combined with T tube drainage of the common bile duct and efficient retroperitoneal drainage should be performed. Damage control surgery should be performed including bypass of bile and pancreatic juice, duodenal diverticularization, retroperitoneal drainage and jejunostomy when delayed injury of bile duct was diagnosed. Second-stage surgery should be performed six months later.