严重十二指肠损伤的治疗

目的探讨严重十二指肠损伤的治疗方法。方法回顾8年间手术治疗的严重十二指肠损伤和胰腺损伤38例患者的临床资料。结果十二指肠憩室化手术8例,5例痊愈,2例肠瘘,死亡1例。胰十二指肠切除9例,3例痊愈,胰瘘6例其中死亡3例。十二指肠直接修补或补片修补16例,13例痊愈,2例发生肠瘘,死亡1例。5例十二指肠修补+胰头切除胰腺空肠吻合(保留十二指肠的胰头切除),4例痊愈,1例胰瘘;其中3例行胰腺空肠捆绑吻合患者,无胰瘘发生,均痊愈出院。结论大部分十二指肠损伤可行十二指肠直接修补或补片修补加可靠的十二指肠和空肠造瘘术;对合并严重胰头部损伤者可在上述手术基础上行保留十二指肠的胰头切除,可获得比较满意的效果。不要轻易使用十二指肠憩室化手术和胰十二指肠切除手术。

Treatment of severe duodenal trauma

Objective:To study  the operative method for severe duodenal trauma.
Methods:The clinical data of 38 cases of severe duodenal trauma complicated with pancreatic injury who underwent different operations between 1992—2006 year were reviewed.
Results:In 8 cases duodenal diverticulization was performed, of which 5 cases were cured, 2 cases developed intestinal fistula, and one  died.Of 9 cases who underwent panceaticoduodenectomy(PD), 3 were cured but 6 had pancreatic leakage, and 3 of them died.Of 16 cases who had primary repair of ruptured duodenum with simple suture or patch suture, 13 cases cured, 2 cases developed intestinal fistula and one patient died.Five patients underwent duodenal repair and excision of head of pancreas plus pancreaticojejunostomy (PD with preserved duodenum), 4 cases recovered and 1 had pancreatic leakage, but 3 with wrap-type pancreaticojejunostomy had no complications.
Conclusions:The repair of ruptured duodenum with simple suture plus duodenostomy and jejunostomy is preferential option for majority of cases of duodenal trauma. This procedure plus removal of head of pancreas and  pancreaticojejunostomy (PD with preserved duodenum) can be used for severe pancreatic injury with excellent result, but duodenal diverticulization or  panceaticoduodennectomy must not be undertaken lightly.