Infectious complications resulting from use of hemostatic puncture closure devices

BACKGROUND: Femoral access site complications have increased as the fields of invasive cardiology, radiology, and endovascular surgery have emerged. In order to address one of these complications, hemorrhage, the hemostatic puncture closure devices were developed. METHODS: Retrospective review of cardiac catheterizations performed at a single institution to investigate infectious groin complications related to use of the Perclose Prostar and Techstar devices. RESULTS: Infectious groin complications were significantly higher in the Perclose group as compared with manual compression. Three patients had clinical and laboratory evidence of arterial infection whereas 2 had soft tissue infections. All 5 required operative intervention ranging from incision and drainage to arterial reconstruction. Hemorrhagic complications were not significantly different between the two groups. CONCLUSIONS: The Perclose devices provide hemostasis after femoral artery catheterization similar to manual compression. However, infectious groin complications appear to be more common with these devices.     

主动脉腔内修复术双Perclose ProGlide交叉缝合与传统缝合穿刺点的疗效比较

目的通过与传统缝合比较,探讨主动脉腔内修复术采用双Perclose ProGlide交叉缝合修复20F或22F穿刺点的优缺点,为临床穿刺点修复方法选择提供参考。方法 2007年6月-2011年5月,103例115侧采用外径为20F或22F输送鞘行主动脉腔内修复术,其中采用双Perclose ProGlide交叉缝合修复穿刺点57例64侧(双Perclose组),传统缝合修复46例51侧(传统缝合组)。两组患者年龄、性别、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果双Perclose组不同病种患者的手术时间、术中出血量、住院时间均明显优于传统缝合组(P<0.05)。术后双Perclose组5例(5侧)、传统缝合组2例(2侧)出现不同程度腹股沟区皮下瘀血;双Perclose组2例(2侧)皮肤穿刺点处淋巴漏,传统缝合组6例(8侧)切口发生淋巴漏。双Perclose组术后早期并发症发生率为7.8%(5/64),传统缝合组为15.7%(8/51),比较差异无统计学意义(χ2=1.76,P=0.19)。双Perclose组技术成功率为96.9%(62/64),传统缝合组为100%(51/51),差异无统计学意义(χ2=0.31,P=0.50)。两组患者术后均获随访,双Perclose组随访时间2～19个月,平均15个月;传统缝合组随访时间2～18个月,平均14个月。双Perclose组1例(1侧)术后3个月出现原穿刺点处假性动脉瘤,给予切开缝合;其余患者无缝合动脉狭窄、假性动脉瘤形成等中期并发症发生。双Perclose组中期并发症发生率为1.6%(1/64),传统缝合组为0,两组比较差异无统计学意义(P=1.000)。结论与传统缝合技术相比,双PercloseProGlide交叉缝合技术修复主动脉腔内修复术中20F或22F穿刺点疗效相似,但在控制手术时间、术中出血量及住院时间方面具有明显优势。     

Femoral artery infections associated with percutaneous arterial closure devices

Hemostasis obtained by manual compression after femoral artery catheterization results in consistently low rates of major complications. A rare complication of femoral artery catheterization is arterial infection. Its occurrence after diagnostic angiography using manual compression has not been reported. We report two cases of femoral arterial infection after uneventful diagnostic catheterization in nonimmunocompromised patients using the Perclose percutaneous arterial closure device. Our cases are representative of Perclose associated infections, with delayed presentation of a staphylococcal arterial infection requiring arterial debridement and reconstruction. This article indicates that Perclose use carries a risk of severe arterial infection. Surgeons should be aware of the potential infectious complications associated with Perclose use and the need for aggressive treatment.     

完全穿刺技术在腹主动脉瘤腔内修复术中的应用

目的 探讨应用Perclose ProGlide缝合器完全穿刺技术行腹主动脉瘤腔内修复术的安全性和有效性.方法 2008年5月至2010年4月,36例腹主动脉瘤患者完全穿刺下行腔内修复术治疗.其中男性30例,女性6例;平均年龄68岁.所应用的支架型血管包括:3例Endurant,13例Talent,20例Zenith.18～24 F的鞘管预置两把ProGlide,14～16 F的鞘管预置单把ProGlide.缝合动脉切口时取出鞘管并将线结下滑收紧.统计技术成功率、相关并发症及手术操作时间.术后3、6、9、12个月及其后每年进行CT血管造影随访.结果 20例局部麻醉,16例全身麻醉.68条股动脉共应用128把ProGlide,其中38条股动脉各应用2把,8条各应用3把,2条各应用4把,20条各应用1把.63条股动脉(63/68,92.6%)技术操作成功,2条中转切开缝合,3条出现血肿,无需手术处理.平均随访时间(12±3)个月.1例于术后3个月出现无症状的动脉夹层.结论 完全穿刺技术在腹主动脉瘤腔内修复术中的应用是安全和有效的.由于可能需要切开缝合,建议在杂交手术室中操作.     

Histologic and duplex comparison of the perclose and angio-seal percutaneous closure devices

The intravascular and extravascular effects of percutaneous closure devices have not been well studied. We assessed the performance and healing characteristics in dogs of two devices approved by the US Food and Drug Administration. Nine adult male dogs were anesthesized prior to percutaneous access of both femoral arteries with a 6F sheath. All dogs were systemically heparinized to an activated clotting time (ACT) > 250 seconds. Duplex sonography was performed preoperatively to measure vessel diameter and flow velocity. In each dog, one of two devices (Perclose, Abbot Laboratories, Abbott Park, IL or Angio-Seal, St. Jude Medical, St. Paul, MN) was randomly deployed into one of the two femoral arteries. The other device was deployed on the opposite side. Duplex sonography was repeated immediately after deployment and 28 days later to measure changes in vessel diameter and flow velocity. At 28 days, angiography was performed on both femoral arteries before they were removed for histologic evaluation. The time required to excise each vessel reflected the degree of scarring. Hemostasis time for the Angio-Seal device far surpassed the Perclose device (39 +/- 7 vs 0 minutes; p < .05). Vessel narrowing was observed only at 28 days after deployment of the Angio-Seal device (p < .05). Extensive extravascular scarring was observed with the Angio-Seal device, which resulted in a longer femoral artery dissection time and greater periadventitial scar thickness compared with the Perclose device (p < .05). When compared with the Perclose suture closure device, the Angio-Seal collagen plug closure device prolonged hemostasis time and produced greater vessel narrowing and periadventitial inflammation (extravascular scarring) in a canine model at 4 weeks.     

Mid-term follow-up of percutaneous access for standard and complex EVAR using the ProGlide device

ObjectivesEndovascular Aneurysm Repair is an established treatment for abdominal aortic aneurysm which requires arterial access via the groin. Most centres perform percutaneous ultrasound-guided access into the common femoral artery for delivery of the stent graft. The profile of endovascular devices necessitates large sheath sizes, therefore formal closure of the arterial puncture site is required. Various percutaneous devices are available, with data lacking on efficacy and mid-term safety profile. We present outcomes from a single centre with the Perclose ProGlide? (Abbott Vascular Devices, CA, USA) suture-mediated system, using the well described “pre-close” technique.Materials & methodsData were collected from operative records and electronic medical records. Patients undergoing standard (EVAR) or complex (F/B-EVAR) aneurysm repair between March 2015 and September 2019 were included. Complications were recorded per-patient and per-groin procedure.Results266 patients were included; 182 (68.4%) standard infrarenal EVAR, 84 (31.6%) F/B-EVAR. There were a total of 484 groin procedures performed. Intraoperative Perclose ProGlide? success was 98.1% (per patient) or 99.0% (per groin procedure). 30-day groin complication rate was 6.1% (per patient) or 3.1% (per groin procedure). There were no pre- or peri-operative factors which predicted the occurrence of groin complications. The rate of groin complications was not related to sheath size.ConclusionsOur data support the use of percutaneous access with a pre-close technique for a variety of endovascular aneurysm repair procedures with both large- and small-bore access. The Perclose ProGlide? system provides excellent mid-term complication-free and reintervention-free outcomes for groin procedures.     

Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy

We report on the transabdominal resection of infected lumbosacral bone, synthetic mesh, and sinus tract following sacral colpopexy. A 45-year-old nulliparous patient who had undergone transvaginal mesh followed by robot-assisted sacral colpopexy presented with increasing back pain and foul-smelling vaginal drainage. An epidural abscess required surgical intervention, including diskectomy, sacral debridement, and mesh removal to drain the abscess and vaginal sinus tract. Recognized complications of open prolapse procedures also manifest following minimally invasive approaches. Osteomyelitis of the sacral promontory following sacral colpopexy may require gynecologic and neurosurgical management.     

����������ǻ���޸�����Ѫ�ܷ�����������п�����ٴ�Ӧ�öԱ��о�

??Comparation between blood vessel suture instrument and traditional surgical suture in EVAR surgery for abdominal aortic aneurysm: An analysis of 130 cases ZHANG Zheng, CHEN Zhong, TANG Xiao-bin, et al. Beijing Anzhen Hospital ??Capital Medical University, Beijing 100029, China
Corresponding author??CHEN Zhong, E-mail??chenzhong8658@vip.sina.com
Abstract Objective To investigate the application of the Perclose Proglide vascular closure devices in the endovascular abdominal aortic aneurysm repairing operation and its significance. Methods The clinical data of 130 cases of endovascular abdominal aortic aneurysm repairing operation performed between March 2013 and February 2015 in Department of Vascular Surgery??Beijing Anzhen Hospital of Capital Medical University were analyzed retrospectively. Among them, 69 cases were treated with Perclose Proglide vascular closure devices to suture the puncture site of the femoral arteries and 61 cases were treated with the traditional surgical suture to close the puncture site of the femoral arteries. The relationship between the two groups and various clinicopathological factors of patients with abdominal aortic aneurysm were analyzed by Chi-square using statistical software SPSS17.0. The clinicopathological factors include operation successful rate??operation time??intraoperative blood loss??hospital stay??cost of operation??wound healing??lower limb ischemia and so on. Results Analysis using chi-square showed that Perclose Proglide vascular closure devices group was obviously better than the other group in operative time, intraoperative blood loss and hospital stay (P<0.05). Conclusion Comparing with the traditional surgical suture method??Perclose Proglide vascular closure devices are safe and effective. The patients have less injury and can recover more quickly??The Perclose Proglide vascular closure devices are worthy of clinical popularization??     

Groin Infection Caused by a Percutaneous Femoral Artery Closure Device: Report of a Case

Hemostasis after femoral artery catheterization is generally achieved by manual compression, which results in a low incidence of infection at the puncture site. Percutaneous femoral artery closure devices have recently been used to prevent bleeding complications, shorten the hospital stay, and reduce the patient's discomfort. However, they have been associated with infectious complications, necessitating surgical intervention, such as patch angioplasty or arterial bypass; the treatment depending on the damage to the artery and the type of device used. Thus, the possibility of infection should be kept in mind when employing these devices. We report a case of groin infection associated with one such device, known as The Closer, which was successfully treated by drainage and removal of the suture material.     

腹主动脉瘤腔内修复术中血管缝合器与手术切开缝合临床应用对比研究

目的 探讨Perclose Proglide血管缝合器在腹主动脉瘤腔内修复手术中的应用及意义。方法 回顾性分析2013年3月至2015年2月,首都医科大学附属安贞医院血管外科临床确诊腹主动脉瘤并实施腔内修复术的130例病人资料。术中采用穿刺股动脉方法建立入路并使用Perclose Proglide 血管缝合器缝合69例（A组）,手术切开股动脉并缝合61例（B组）。分析两组在缝合成功率、手术时间、术中出血量、住院时间、手术费用、伤口愈合情况、有无下肢缺血等因素,探讨Perclose Proglide 血管缝合器在腹主动脉瘤腔内修复手术中的应用效果。结果 在130例病人中,与手术切开组（B组）相比,使用缝合器组（A组）手术时间更短、术中出血量少、且住院时间较短,且差异均有统计学意义（P<0.05）。结论 在腹主动脉瘤腔内修复手术中,经皮穿刺建立股动脉入路并使用Perclose Proglide 血管缝合器处理穿刺点,该方法安全有效,且创伤小,病人术后恢复更快,值得推广使用。     

Recurrent surgical site infection after anterior cruciate ligament reconstruction: A case report

BACKGROUND Surgical site infections following anterior cruciate ligament(ACL) reconstruction are an uncommon but potentially devastating complication.In this study, we present an unusual case of recurrent infection of the knee after an ACL reconstruction, and discuss the importance of accurate diagnosis and appropriate management, including the issue of graft preservation versus removal.CASE SUMMARY A 33-year-old gentleman underwent ACL reconstruction using a hamstring tendon autograft with suspensory Endobutton fixation to the distal femur and an interference screw fixation to the proximal tibia.Four years after ACL reconstruction, he developed an abscess over the proximal tibia and underwent incision and drainage.Remnant suture material was found at the base of the abscess and was removed.Five years later, he re-presented with a lateral distal thigh abscess that encroached the femoral tunnel.He underwent incision and drainage of the abscess which was later complicated by a chronic discharging sinus.Repeated magnetic resonance imaging revealed a fistulous communication between the lateral thigh wound extending toward the femoral tunnel with suggestion of osteomyelitis.Decision was made for a second surgery and the patient was counselled about the need for graft removal should there be intraarticular involvement.Knee arthroscopy revealed the graft to be intact with no evidence of intra-articular involvement.As such, the decision was made to retain the ACL graft.Re-debridement, excision of the sinus tract and removal of Endobutton was also performed in the same setting.Joint fluid cultures did not grow bacteria.However, tissue cultures from the femoral tunnel abscess grew Enterobacter cloacae complex, similar to what grew in tissue cultures from the tibial abscess five years earlier.In view of the recurrent and indolent nature of the infection, antibiotic therapy was escalated from Clindamycin to Ertapenem.He completed a six-week course of intravenous antibiotics and has been well for six months since surgery, with excellent knee function and no evidence of any further infection.CONCLUSION Prompt and accurate diagnosis of surgical site infection following ACL reconstruction, including the exclusion of intra-articular involvement, is important for timely and appropriate treatment.Arthroscopic debridement and removal of implant with graft preservation, together with a course of antibiotics,is a suitable treatment option for extra-articular knee infections following ACL reconstruction.     

Pseudoaneurysm of the popliteal artery after hardware removal in a patient with Marfan syndrome

The formation of pseudoaneuryms after orthopaedic procedures in the setting of connective tissue disorders such as Marfan syndrome (MFS) is not well documented in the literature. We report the case of a seventy-one year old male with MFS who underwent uncomplicated distal interlocking screw removal from a femoral cephalomedullary nail for symptomatic hardware. Five weeks later, he presented with a popliteal artery pseudoaneurysm. The patient underwent successful open ligation and excision of the pseudoaneurysm. This is the first reported case of a popliteal artery pseudoaneurysm following orthopaedic hardware removal in a patient with MFS. MFS may predispose patients to peripheral vascular complications even in the most routine cases. A thorough understanding of the patient and complications associated with MFS is required prior to proceeding with elective orthopaedic surgery.     

Can the Perclose suture-mediated closure system be used safely in patients undergoing diagnostic and therapeutic angiography to treat chronic lower extremity ischemia?

PURPOSE: Mechanical closure devices for arterial hemostasis after angiography, such as the Perclose suture-mediated closure system, are designed to decrease time to ambulation and improve patient comfort. Although these devices are safe and efficacious, to date there has been little reported about use of the Perclose device in a cohort consisting exclusively of patients with lower extremity peripheral vascular disease. The purpose of this study was to determine the safety and efficacy of routine use of the Perclose system in patients with documented peripheral vascular disease undergoing angiography to treat chronic lower extremity ischemia. METHODS: The Perclose device was placed for arterial closure after femoral artery access in 500 consecutive patients with documented peripheral vascular disease (ankle-brachial index, <0.8) who underwent diagnostic angiography or percutaneous intervention because of chronic lower extremity ischemia. These 500 patients composed 91% of all patients who underwent angiography because of chronic lower extremity ischemia between January 1, 2001, and April 1, 2002. All complications associated with the Perclose device were identified and reviewed. RESULTS: Of the 500 arteries, 54% were accessed for diagnostic angiography and 46% for intervention. Perclose device placement was successful in 475 attempts (95%). Overall major complication rate was 1.4% (7 of 500 arteries). Complications included one death from retroperitoneal hemorrhage; three episodes of limb ischemia, two requiring operation and one requiring lytic therapy; two pseudoaneurysms; and one hematoma, which prolonged hospitalization. The hematoma was the only complication in the 25 patients with failed Perclose device placement. There were no infections requiring admission or operation. CONCLUSION: The Perclose suture-mediated closure device is efficacious and can be used safely in selected patients with documented peripheral vascular disease. Complications associated with this device tend to be more severe than those historically reported for manual compression. Substantial experience with use of this device is required to achieve excellent results in patients with difficult anatomy.     

Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the Preclose technique

OBJECTIVE: Percutaneous access during endovascular aortic repair has been shown to be feasible and safe using a suture-mediated closure device ("Preclose" technique) for closure of up to 24F introducer sheaths. The purpose of this study is to examine the late outcomes of those femoral arteries repaired in this manner. METHODS: The Preclose technique has been previously described. Briefly, the technique involves two Perclose Proglide devices deployed in the femoral artery prior to insertion of the large diameter introducer sheath and then closure of the arteriotomy by tying down knots of the Proglide following removal of the sheath. The medical records of all patients who underwent endovascular aortic repairs using the Preclose technique between December 2004 and August 2007 were reviewed. Follow-up protocol consisted of computed tomography (CT) angiograms performed at 1, 6, and 12 months, and annually thereafter. All Preclose patients who had at least a 6-month postoperative scan were included in the study. For each patient, the most recent postoperative scan was compared with the preoperative scan for evidence of any new anatomic abnormalities of the femoral artery such as dissection, stenosis, or pseudoaneurysm. Three-dimensional post processing with multiplanar reconstructions was also performed as necessary to confirm axial scan findings. RESULTS: A total of 292 patients underwent percutaneous endovascular aortic repairs (TEVAR-125, EVAR-167). Four hundred thirty-two femoral arteries were closed with 870 devices. Four hundred eighteen vessels were approximated with two devices, while 30 arteries required three devices for hemostasis and an additional four vessels only required a single device. Two hundred seventy-eight (64.3%) vessels were accessed with sheaths 18 to 24F. Four hundred eight femoral arteries (94.4%) were closed successfully with the Preclose technique. There were 100 patients (TEVAR-35, EVAR-65) who had adequate postoperative CT scan at 6-months or later. The mean follow up was 11.6 +/- 5.0 months. Of the 156 femoral arteries in these 100 patients repaired using the Preclose technique, there were 3 late complications in 3 patients, 1 asymptomatic femoral artery dissection, and 2 femoral artery pseudoaneurysms requiring surgical repair, resulting in a late complication rate of 1.92% (3/156). CONCLUSION: Percutaneous closure of femoral arteries after large diameter introducer sheaths using the Preclose technique has a low incidence of early and late complications related to the closure site.     

Total percutaneous cardiopulmonary bypass with Perclose ProGlide

Suture-mediated closure devices have been previously described as an interesting alternative to femoral cutdown during endovascular aortic procedures. The insertion of two or three devices before the cannulation (preclose technique) permits successful percutaneous access also with a large sheath up to 24 Fr diameter. The main benefit of percutaneous access is a lower rate of complication at the groin. The same technique can be applied to cardiac procedures where femoral cannulation for cardiopulmonary bypass (CPB) is required. We report a series of 12 patients in whom total percutaneous CPB was successfully established using a Perclose ProGlide for the arterial access.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

评估Perclose Proglide血管缝合器在胸主动脉夹层腔内修复术中的应用

目的探讨Perclose Proglide血管缝合器在胸主动脉夹层腔内修复术(TEVAR)中的应用价值。方法回顾性分析在我科采用TEVAR治疗Standford B型主动脉夹层患者106例,术后1个月、1年行CTA复查,分别测量术前、术后1个月、术后1年穿刺区股动脉直径大小。结果 106例患者均顺利完成覆膜支架腔内隔绝术,共使用223把缝合器,其中97例患者2把缝合器,7例患者3把缝合器,2例患者4把缝合器。术前、术后1个月、术后1年CTA测量穿刺区股动脉直径比较差异无统计学意义(P均0.05)。结论 Perclose Proglide血管缝合器在TEVAR中封闭股动脉穿刺道安全、可靠,且对股动脉管径无明显影响,值得推广。     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.     

胆胰肠结合部损伤的诊断和治疗

目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查后确诊,并多次行清创、引流手术,其中1例治愈,1例死亡.结论 早期诊断和及时、合理地治疗是取得良好疗效的关键.术中胆道造影、纤维胆道镜是确诊胆胰肠结合部损伤的有效方法.对于首次术中确诊者,可行损伤处修补+引流治疗.对于术后确诊并出现腹腔、腹膜后脓肿及蜂窝组织炎者,应充分清创、引流,必要时加行胆汁、胰液分流、十二指肠憩室化手术.