医源性胆胰肠结合部损伤

胆胰肠结合部解剖位置及组织结构特殊，极易在手术操作中受到损伤并产生严重后果，因此，亟待对医源性胆胰肠结合部损伤进行深入的临床研究。胆胰肠结合部损伤的原因主要包括解剖因素、病理学因素及医源性因素；诊断包括术中诊断及术后延迟诊断；治疗主要包括术中缝合修补、T管引流，术后清创引流、胆胰分流、十二指肠憩室化、空肠造瘘及胃肠道和胆道重建；术中的精细操作，手术末预防性行T管注水、T管造影、胆道镜等检查可有效预防医源性胆胰肠结合部损伤。有效的预防及早期合理的损伤控制外科治疗，可降低医源性胆胰肠结合部损伤的发生率及病死率。

Diagnosis and management of iatrogenic choledocho-pancre-atico.duodenal junction injury

The anatomy and position of choledocho pancreatico duodenal junction are unique, so choledocho pancreatico duodenal junction is easily be injured during operation, and thus it needs further investigation. Anatomical, pathological and iatrogenic factors are the 3 main causes of choledocho pancreatico duodenal junction injury. The diagnosis of choledocho pancreatico duodenal junction injury includes intraoperative and postoperative diagnosis; and the treatment methods include intraoperative repaire and suture, T tube drainage, postoperative debridement and drainage, biliopancreatic shunt, duodenal diverticulum, jejunum stoma, gastrointestinal and biliary reconstruction. Precise operation, T tube cholangiography, choledochoscopy can effectively prevent the choledocho pancreatico duodenal junction injury. The principle of early discovery, early management, avoiding over management, and promoting damage control surgery should be awared to reduce the mortality.