胆道手术中十二指肠损伤的原因及防治

目的 探讨胆道手术中十二指肠损伤的原因及防治方法。方法 对我院从1990年3月-2002年6月诊治的10例胆道手术致十二指肠损伤的临床资料作回顾性分析。结果 2例因分离十二指肠与肝胆广泛粘连而损伤十二指肠前壁51例十二指肠被误认为胆总管而切开;7例在金属探条探查胆道时致十二指肠损伤。处理方法分别用损伤修补、十二指肠腔内外引流和胃空肠造瘘术。术中及时发现6例均治愈;术后诊断4例,1例保守治愈,3例分别经多次手术,其中1例死亡。结论 胆道手术中十二指肠损伤的防范是主要的,而早期发现及选择恰当的处理方法是治疗成功的关键。

THE REASONS AND PREVENTION AND TREATMENT OF DUODENAL INJURY IN THE BILIARY OPERATIONS

Objective To explore the reasons and prevention and treatment of duodenal injury in the biliary operations.Methods The clinical data of 10 patients with duodenal injuries who were treated in our unit from March of 1990 to June of 2002 were analyzed retrospectively.Results There were 2 patients with anterior wall injuries by dividing the infective adherence between the duodenum and hepatobiliary position; 1 patient with duodenal wall being opened as common bile duct; 6 patients with posterior and 1 with anterior duodenal wall injuries by exploration of backer's probe. The methods of treatment were carried out the repair duodenal injury, placed the drainage tube in intro or extra duodenum and gastrojejunostomy. In this group 6 patients whose injuries were found timely in the operations were cured, 3 of the other 4 had been operated several times and 1 died. Conclusion It is important to treat successfully by finding injury earlier and using reasonable therapeutic methods.