闭合性十二指肠损伤的早期诊断及手术方式选择

目的探讨闭合性十二指肠损伤的临床特点、早期诊断及手术方式选择。方法回顾性分析1990年~2005年收治的19例闭合性十二指肠损伤病例资料。术前确诊3例(15.8%),术中确诊14例(73.7%),漏诊2例(10.5%)。结果19例均行手术治疗,其中行单纯十二指肠破裂修补术3例;十二指肠修补加带蒂浆肌片覆盖2例;十二指肠端端吻合术2例;十二指肠空肠端侧或侧侧Roux-en-Y吻合8例;十二指肠憩室化手术3例,胰头十二指肠切除1例。术后发生并发症7例(36.8%),其中十二指肠瘘4例,胰瘘1例,切口裂开2例。治愈16例(84.2%),死亡3例(15.8%)。结论掌握闭合性十二指肠损伤的特点,注重早期诊断、早期手术,加强术中探查,选择合理术式是提高治愈率,降低死亡率的关键。

Early Diagnosis and Surgical Strategy of Closed Duodenal Injury

Objective To explore the clinical presentation,early diagnosis and the surgical strategy of closed duodenal injury.Methods 19 cases of closed duodenal injury were retrospectively reviewed.Diagnosis was established in 3 cases preoperatively,and 14 cases intraoperatively.2 cases were misdiagnosis.Result All the cases underwent surgical treatment,including repair in 3 cases,repair with vascularized jejunal flap in 2 cases,end to end duodenal anastomosis in 2 cases,Roux-en-Y duodenojejunostomy in 8 cases,duodenal diverticularization in 3 cases,Whipple's procedure in 1 case.There were 7 cases experienced postoperative complications,including duodenal fistula in 4 cases,pancreatic fistula in 1 case and wound dehiscence in 2 cases.3 death occurred.Conclusions A reduced mortality can be achieved on a basis of early diagnosis and intervention with better understanding of clinical presentation and better intraoperative investigation.