十二指肠损伤的诊断和术式选择

目的 总结15例十二指肠损伤治疗的临床经验,提高十二指肠的外科治疗水平。方法 对6例发病时间在12h以内,破口在2.5cm以内,行单纯十二指肠修补术;7例发病时间超过12h或破口大于2.5cm,感染严重者行十二指肠修补或行带蒂室肠修补加十二指肠造瘘术;2例因严重的多发性的损伤行胰十二指肠切除术。结果 全组无1例死亡,术后并发症有腹腔脓肿2例,肠梗阻1例。结论 早期诊断,对有手术指征病人的早期手术和细致的手术探查是非常重要的,根据病程,破口大小选择合理的术式及充分引流对提高治愈率是必要的。

Diagnosis and choice of surgical procedure for trauma of the duodenum

To summarize the clinical experience of fifteen patients with duodenal injury and im-prove the surgical therapeutic level of duodenal injury. Metheds To the 6 patients with stoma of rupture less than 2.5cm in diameter and within 12 hours after injury, a simple duodenal repair was performed. To the 7 pa-tients with stoma of rupture more than 2.5cm in diameter,Over 12 hours and seriously infected,a direct duode-nal repair with or without jejunum and duodenostomy were performed. To the 2 patients with severe and multi-ple injuries, a pancreaticoduodenectomy was performed. Results No death in all cases. Postoperative complica-tions were found in 2 cases with abscess of abdominal cavity and in 1 case with intestinal obstruction. Conclusion Early diagnosis, early operation to the patients with surgical indications and meticulous intraoperative explo-ration were very important. The selection of reasonable operative manner according to the time and size of the rupture of duodenal injury are necessary to improve the cure rate.