胆胰肠结合部疾病的诊治策略

Diagnosis and treatment of diseases in biliary-pancreatic-duodenal junction

胆胰肠结合部疾病具有疾病谱广、临床表现相似、早期诊断困难、术前与术中定性诊断困难导致术式选择困难、手术难度与创伤大和保留脏器功能难等特点.其诊断应坚持"追踪症状、顺序检查、分类随访、适时探查"的原则,治疗应坚持"合理、彻底"的原则.良性病变应采用尽量保留胆胰肠结合部结构与功能的术式.术式合理是微创的核心.控制性手术是治疗延迟发现的胆胰肠结合部损伤的关键.Oddi氏括约肌功能障碍的治疗应遵循"以测压为基础,先无创再有创"的原则.

The diseases originating from the biliary-pancreatic- duodenal junction have similar clinical features, such as common clinical manifestations, difficulty in early diagnosis and selection of proper surgical procedure due to right qualitative diagnosis pre- and post- operatively, the complexity and big trauma of operation, and difficulty in preserving the function of organs. The diagnostic principles including ＂tracking symptoms, sequential examination, follow-up with classification, and timely exploration＂ should be abided. The treatment strategy should be ＂reasonable and radical＂. The surgical procedures for benign lesions should preserve the function of organs as much as possible. Reasonable surgical selection is the core of minimally invasive treatment. Damage control operation is the key point to successfully treat iatrogenic injury discovered with delay. The treatment of sphincter of Oddi dysfunction should follow the principle of noninvasive procedure prior to invasive procedure on the basis of sphincter of Oddi manometry.