损伤控制外科时代胆胰肠结合部损伤的治疗

目前,学术界对胆胰肠结合部范围的界定尚有争议.本文是指广义的胆胰肠结合部,包括胰头、胆总管下段、十二指肠降部及胰头周围软组织.医源性胆胰肠结合部损伤并不少见,但外伤所导致的却较少.由于此部位损伤的病死率及手术相关并发症发生率甚高,没有一个统一的治疗模式为大家所借鉴,因此对外科医生而言,胆胰肠结合部损伤的处理仍是一个巨大的挑战.近年来,损伤控制外科(damage control surgery,DCS)理念的提出及在损伤救治中的广泛应用,对胆胰肠结合部损伤的救治产生了深刻的影响.

Treatment of injury in choledocho-pancreatico-duodenal junction in the era of damage control surgery

Injuries in the choledocho-pancreatico-duo-denal junction are rare, and are frequently associated with other severe vascular and visceral injuries. Interventions during early operation may aggravate the condition of patients, while proper application of damage control surgery (DCS) is helpful in raising the survival rate. Therefore, for most of the patients with choledocho-pancereatico-duodenal junction injury, definite opera-tion should be performed after removal of necrotic tissues, control of infection and adequate drainage. However, DCS should be applied with caution, and the indications of DCS should be strictly followed, because reoperation will increase the chance of injury and infection after DCS.