摘要
胆道手术中十二指肠损伤是胆道外科中难以回避的问题,多由于解剖结构辨识不清、操作粗暴造成,也可因胆道病变局部炎症或肿瘤等病理因素波及十二指肠而造成难以避免的外科损伤所致。十二指肠前壁损伤通常发生在腹腔内,易于发现和及时处理;后壁损伤位于腹膜后,位置隐匿,难于即刻发现,加之腹膜后组织结构疏松,更易造成广泛侵蚀与感染。术前进行充分而精准的影像学预判、术中高度重视组织结构与解剖关系的辨认、操作轻柔精细,是预防胆道术中十二指肠损伤的关键。胆道术中十二指肠损伤一旦发生,切忌心存侥幸,务求做到不遮掩、不回避,在损伤修补处理上遵循可靠缝合、充分减压、通畅引流的原则。术后延迟发现的损伤,处理更棘手,胃肠道改道、造口,彻底减压旷置损伤肠段,以及充分合理的肠外与肠内营养支持治疗,是争取救治成功的关键。
Duodenal injury is inevitable in the biliary surgery due to the complicated antanomy, roughly surgical procedures,duodenum invasion caused by infection or tumor, etc. The injury of anterior wall of duodenum can be easily identified and handled,while the injury of posterior wall is more difficult to indendify and can cause serious retroperitoneal corrosion and infection. Precise imaging assessment before operation,carefully identification of the complex anatomy relationships,gentle surgical procedures are the key points to prevent duodenalinjury. Once the duodenal injury occurs,it should be handled carefully in a timely manner. Reliable suture,adequate decompression and drainage are the basicaltreatment principles. The postoperative delay detection of duodenal injury is more difficult to handle. Patients may benefit from gastrointestinal diversion, jejunum stoma,exclusion the damage duodenum,which are the key resources to achieve good prognosis.
出处
《中国实用外科杂志》
CSCD
北大核心
2015年第3期275-276,共2页
Chinese Journal of Practical Surgery
关键词
十二指肠损伤
胆道手术
营养支持
duodenal injury
biliary tract surgery
nutritional support
