摘要
胆胰结合部解剖结构特殊、病变后局部组织改变、加上该处手术常在非直视下进行,所以稍有不慎易引起医源性损伤。伤后症状隐蔽往往延误诊治,致后果十分严重。早期(术中)诊断的关键是:凡该处手术要警惕损伤的可能,时时观察有无意外损伤。如明确损伤、T管注水后后腹膜水肿或渗液、造影见造影剂外渗,要努力找到损伤点立即修补,并作胆总管T管引流。如伴十二指肠损伤还要十二指肠减压引流。若找不到损伤点,则将胆管切断后胆肠Roux-en-Y吻合,使胆胰完全分流更妥。术后1～2d出现寒战、高热、右腰背痛,往往是术中漏诊后腹膜后漏出物积聚、感染的表现;脓液可向下扩散达右髂窝,出现右下腹痛、压痛。此时要及时手术作脓疡沏底引流、胆胰分流、十二指肠憩室化及空肠营养性造瘘。
Iatrogenic trauma of the pancreaticobiliary junction is sometimes inevitable because of its unique anatomy, special pathologic changes and some operations undergoing without direct vision. Because the clinical features are usually inconspicuous, which is responsible for delayed diagnosis, the result is disastrous. The surgeon should always remind himself of the possibility of accidental trauma during operations on that area, which is the key for prevention and early detection. Retroperitoneal edema or exudates after injection into the T tube or exudation of contrast medium during cholangiography implies the existence of trauma. It should immediately make great effort to locate the site, suture the leak and drain the bile. If the leakage can＇ t be located, end-to-side choledochojejunostomy is recommended to separate the biliary and pancreatic flow. Chill, fever and back pain 1-2 days after operation are the signs of leakage in the retroperitonaeum and infection. Sometimes the pus may flow to the right iliac fossa which may cause right lower quadrant abdominal pain and tenderness. Prompt surgery to drain the abcess, separate the biliary and pancreatic flow, diverticularize the duodenum and jejunostomy for enteral nutrition is necessary.
出处
《中国实用外科杂志》
CSCD
北大核心
2010年第5期363-365,共3页
Chinese Journal of Practical Surgery
关键词
胆胰结合部
医源性损伤
pancreaticobiliary junction
iatrogenic trauma
