医源性十二指肠后壁或胆总管下段损伤

目的 探讨医源性胆总管下段或十二指肠后壁意外损伤原因及预防方法。方法 6例病人均患胆总管结石，行胆总管切开探查取石，因使用金属胆道探子致十二指肠后壁损伤或胆总管下段损伤。结果 前4例死亡；第5例抢救治疗存活，但耗资巨大；第6例术中及时发现，行胰十二指肠切除术，术后顺利。结论 常规使用金属胆道探子探查胆道，易导致胆总管下段或十二指肠后壁损伤。作者提倡用导尿管探查胆道下端，具有使用方便、安全可靠的特点。造成损伤后术中及时发现并妥善处理尤为重要。

Iatrogenic injury of common bile duct and posterior wall of duodenum

Objective To investigate the reasons for iatrogenic injury of the distal common bile duct or the posterior wall of duodenum and explore measures for its treatment. Methods Six patients with calculus of the common bile duct were treated with choledocholithotomy. Because the biliary tract probe was metal and hard, the distal common bile duct or the posterior wall of duodenum was injured. Results The first 4 patients died. The 5th patient was alive after treatment but the cost was too high. The injury was detected during choledocholithotomy and timely managed in the 6th patient. Thus the 6th patient survived. Conclusions Routine use of metal probe for exploration the bile duct may cause injury of common bile duct or the posterior wall of duodenum. The authors advocate exploring the distal common bile duct with the urethral catheter, which is safe and convenient. Timely finding and management of the injury during operation is very important.