胆胰肠结合部医源性损伤诊治及预防

Advances in the diagnosis and treatment of iatrogenic injuries in the choledocho-pancreatico-duodenal-junction

胆胰肠结合部(CPDJ)医源性损伤发生隐匿,易漏诊与误诊,可导致严重并发症。近年来,随着胆石病发病率的不断增高、胆胰手术的普遍开展以及内镜和胆道镜等技术的深入推广,CPDJ医源性损伤发生逐渐增多。损伤处理方式和时机选择仍存在一定争议,治疗方案因人、因时而异。目前,多以"损伤控制性外科"理念为原则,继而进行"个体化"分期手术治疗。但二次手术治疗成本高、风险大、病人预后不佳,因此,防胜于治,全面而细致的防治思维可为病人提供更好的治疗效果。而对于CPDJ医源性损伤的监测及诊断技术有待进一步优化。

The iatrogenic injury of the choledochopancreatico-duodenal-junction(CPDJ) occurs with hidden onset,and it is easy to be missed and misdiagnosed,and can lead to serious complications.In recent years,with the increasing incidence of cholelithiasis,the wide spread development of pancreaticobiliary surgery,and the in-depth promotion of endoscopy and choledochoscopy,the iatrogenic injuries of CPDJ have been occurring more frequently.There are still some controversies about the methods and right timing of treatment,and the treatment plans vary from person to person and from time to time.At present,the guidelines of "damage control laparotomy" is the basic principle,followed by "individualized" staged surgery.However,due to the high cost and risk of secondary surgery,the patient’s prognosis is poor.Therefore,prevention is better than cure,and comprehensive and meticulous thinking of prevention and treatment can provide patients with better treatment results.And the monitoring and diagnosis technologies of the iatrogenic injury of CPDJ need to be further optimized.