胆胰肠结合部损伤延迟发现的处理

医源性胆胰肠结合部损伤延迟发现是指在手术中没有及时发现,在术后出现相关临床表现后才发现的损伤,其病死率高达50%～100%[1-3].因此,对于胆胰肠结合部术中损伤未能及时发现的患者,应尽早作出正确的诊断,采取合理的手术方式,尤其是将损伤控制外科的原则运用于此类患者的处理中.这对于提高救治成功率、改善预后十分重要.

Management of delayed-diagnosed iatrogenic injury in cho-ledocho-pancreatico-duodenal junction

Iatrogenic injury in choledocho-pancreatico-duodenal junction is usually difficult to discover in the course of operation because of its unique anatomical position. The injury can lead to postoperative chilis, fever, pain and swelling of the waist, which would easily be misdiagnosed as acute necrotizing pancreatitis. Controlling operations, such as bile and pancreatic juice separation, duodenal diverticularization, jejunal fistulation for enteral nutrition and abdominal drainage should be performed in dealing with the injury in choledocho-pancreatico-duodenal junction. Combined application of pyloric suture with absorbable thread and ligatian, gastric fistulation, ligation of the distal common bile duct and T-tube drainage is minimally invasive, and can fulfill a fully separation of bile and pancreatic juice and duodenal diverticularization. It will improve the possibility of secondary radical operation by ameliorating pyemia and general nutritional condition.