闭合性十二指肠损伤15例诊疗体会

目的　提高对闭合性十二指肠损伤的诊疗水平。方法　对本组闭合性十二指肠损伤1 5例的病因、伤情、探查时间、手术方法、术后并发症及死亡率作了统计和分析。结果　单纯十二指肠损伤 1例 ,多发伤 1 4例 ,并发症 7例 ,治愈 1 0例 ,死亡 5例 ,死亡原因均为创伤性休克或感染性休克。结论　早期诊断、及时探查和选择合适的手术方式 ,是提高疗效减少并发症、降低死亡率的关键     

十二指肠损伤的诊断和治疗

目的 对十二指肠损伤的临床特点，诊断及外科治疗进行分析，以期提高十二指肠损伤的外科治疗水平。方法 回顾性分析收治的46例十二指肠损伤的临床资料。结果 单纯性十二指肠损伤仅2例，有合并伤者44例。46例均经手术治疗，治愈39例（84．8％），术后并发症11例（23．9％），死亡9例（19．6％）。结论 掌握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，掌握好探查指征，根据伤情选择合理，恰当的术式，加强术后管理，可提高治愈率。     

十二指肠损伤的诊治体会

目的:探讨十二指肠损伤的诊断及处理。方法:回顾分析16例十二指损伤的临床资料。结果:术前确诊3例,术中确诊13例,治愈14例,死亡2例。结论:十二指肠损伤术前诊断困难,强调术中探查,防止漏诊。根据不同伤情选择有效的术式,术后充分有效的十二指肠腔内减压,促进损伤愈合。     

十二指肠损伤的诊治体会

目的提高十二指肠损伤的诊疗水平。方法对本组十二指肠损伤12例的病因、伤情、术后并发症及死亡率进行统计和分析。结果单纯十二指肠损伤3例，多发伤9例；并发症7例；治愈10例，死亡2例，均死于十二指肠瘘合并腹腔严重感染。结论早期诊断、术中仔细探查、术后保持引流通畅、营养支持、密切观察病情变化、尽早再次手术是影响十二指肠损伤预后的重要因素。     

十二指肠损伤的诊断及治疗

目的探讨十二指肠损伤在基层医院的诊断和治疗经验。方法回顾本院1996年1月至2009年12月收治的12例十二指肠损伤病例资料,对十二指肠损伤的诊断、损伤分级、手术方式、治疗效果以及术后并发症等进行分析和总结。结果采用单纯缝合修补、十二指肠修补加减压、十二指肠空肠Roux—en—Y吻合和十二指肠憩窒化等手术方式,并配合腹腔冲洗和肠内营养等手段进行治疗。全组治愈11例,死亡1例。发生术后并发症3例,其中十二指肠瘘2例,腹腔脓肿1例。结论早期诊断,及时手术并选择简单合理的个性化手术方式是治疗十二指肠损伤的关键,十二指肠损伤术后并发症发生率较高,应当有预见性,在术中即采取预防措施放置多根引流管和空肠营养管。     

13例十二指肠损伤的诊治分析

目的总结十二指肠损伤的诊断和治疗经验。方法对我院1989年1月至2003年7月期间收治的13例十二指肠损伤患者的临床资料进行回顾性分析。本组均经手术治疗．行十二指肠单纯修补术6例，十二指肠憩室化手术1例，改良憩室化术4例(3例缝扎十二指肠)，Roux-en-Y吻合术1例，T管引流及脓肿切开引流术1例。结果治愈11例；死亡2例，其中1例死于十二指肠瘘，另1例死于肝功能不全。结论十二指肠损伤的早期诊断和手术处理非常重要；缝扎十二指肠的改良憩室化手术是治疗重症十二指肠损伤的一种较理想术式。     

十二指肠损伤治疗体会

目的：探讨十二指肠损伤治疗体会。方法对收治的11例十二指肠损伤的临床质料作回顾性分析。结果治愈10例，治愈率90．91％．术后并发症1例9．09％，无死亡。结论掌握十二指肠损伤的临床特点，提高术中探查的确诊率，根据伤情选择合理的手术方式．建立有效的十二指肠引流减压及术后足量抗酸药物及生长抑素的应用是提高治愈率的关键。     

闭合性十二指肠损伤21例外科治疗体会

目的提高闭合性十二指肠损伤早期确诊率和选择适合的手术方法。方法对本院1987~2004年手术治疗的21例十二指肠损伤病人临床资料进行回顾性分析,报道我院采用三管减压引流法应用于15例十二指肠损伤手术的治疗经验。结果术后十二指肠瘘2例,腹腔内脓肿2例,胰瘘1例,肺部感染1例,多脏器功能衰竭2例。治愈19例,死亡2例。结论十二指肠损伤的早期诊断和合理术式应用是非常重要的,采用三管减压引流法治疗十二指肠损伤简便、易行,十二指肠内减压充分,效果好。     

十二指肠损伤诊治体会

目的 探讨十二指肠损伤的诊断及治疗方法。方法 9例十二指肠损伤患者进行回顾分析。结果 所有患者均在剖腹探查时明确诊断。5例合并伤患者在短期内死亡。4例单纯性十二指肠损伤中,3例行修补加十二指肠胃造瘘,1例行十二指肠-空肠Roux-en Y吻合术治愈,随防1～8年无严重并发症。结论 十二指肠损伤病情复杂,临床诊断困难,易于漏诊及误诊。对腹部损伤患者术前及术中应考虑到十二指肠损伤的可能性,及时诊断并作出恰当处理是改善患者预后的关键。     

十二指肠损伤19例诊治体会

目的:分析讨论十二指肠损伤的诊断及治疗方法.方法:回顾1995年1月-2004年12月收治的19例病人的诊断及治疗进行分析.结果:治愈17例,出现并发症1例,死亡2例.结论:重视对十二指肠损伤的早期诊断以及适当有效的术式选择是提高治愈率,减少并发症降低死亡率的关键.     

外伤性十二指肠损伤的诊治(附35例临床报告)

目的探讨外伤性十二指肠损伤的诊治方法。方法对我院收治的35例外伤性十二指肠损伤病例的诊断与治疗进行回顾性分析。结果35例均进行了手术治疗，治愈29例，死亡6例。死亡率为17．14％，术后并发症发生率为17．14％(6／35)。本组死亡病例均为在伤后12小时接受手术者。结论掌握好早期手术探查指征和选择合适的术式是治疗十二指肠损伤的重要原则。有效的腹膜外引流、腹腔内引流及充分的十二指肠液和胃液转流，是成功治疗十二指肠损伤的关键性措施。导致病人死亡的主原因是误诊和漏诊以至于延误手术时机。     

胰十二指肠合并伤的外科治疗体会

目的 探讨胰十二指肠外伤后手术方式的选择和手术效果。方法 对１９８８￣１９９８年１０年间手术治疗的８例胰十二指肠合并伤病人的临床资料进行了回顾性分析。结果：①１０年间收治胰腺外伤３２例,其中胰十二指肠合并伤８例（２６％）;②术前均未明确诊断,术中１例漏诊;③在十二指肠损伤修补的基础上,行胰腺清创６例,胰腺次全切除１例,胰尾加脾切除１例,其中５例行十二指肠憩室化术。④术后胰瘘４例,十二指肠瘘２例,腹     

严重多发伤中十二指肠破裂的诊治

目的 探讨在严重多发伤中十二指肠破裂的诊治。方法 回顾分析严重多发伤中十二指肠破裂２６例的临床资料。结果 术前及术中确诊２１例,误诊和漏诊５例。行破裂的十二指肠一期修补６例,胃切除,胃肠吻合９例,修补加空肠造瘘４例,修补加十二指肠憩室化３例,十二指肠空肠Ｒｏｕｘ－ｅｎ－ｙ吻合４例。本组治愈１９例（７３．１％）,死亡７例（２６．９％）,结论 正确处理和恰当的术式是救治严重多发伤十二指肠破裂的关键。     

Conservative management of duodenal trauma: a multicenter perspective

The experience of eight trauma centers with duodenal injuries was analyzed to identify trends in operative management, sources of duodenal-related morbidity, and causes of mortality. During the 5-year period ending December 1988, 164 duodenal injuries were identified. Patient ages ranged from 5 to 78 years. There were 38 Class I, 70 Class II, 48 Class III, four Class IV, and four Class V injuries. Injury mechanism was penetrating in 102 (62%) patients and blunt in 62. Primary repair of the duodenal injury was performed in 117 (71%) patients, including 27 patients also managed with pyloric exclusion and 12 with tube duodenostomy. Duodenal resection with primary anastomosis was used in six (4%) patients and pancreatoduodenectomy was necessary in five (3%). There were 30 (18%) deaths. The cause of death was uncontrolled hemorrhage from severe hepatic or vascular injuries in 22 (73%) patients. In only two (1%) patients could death be attributed to the duodenal injury; each as the result of duodenal repair dehiscence and subsequent sepsis. Duodenal-related morbidity was documented in 29 (18%) patients, including 22 patients with intra-abdominal abscess, six with duodenal fistula, and five with frank duodenal dehiscence. In summary, this analysis demonstrated: 1) the great majority of duodenal injuries can be managed by simple repair; 2) tube duodenostomy is not a mandatory component of operative treatment; 3) pyloric exclusion is a useful adjunct for more complex injuries; 4) pancreatoduodenectomy is rarely necessary for civilian duodenal trauma; 5) morbidity following duodenal trauma is more dependent on associated intra-abdominal injuries than the extent of duodenal trauma; and 6) mortality following duodenal injuries is primarily related to associated vascular and hepatic trauma.     

外伤性十二指肠损伤漏诊的临床分析

目的：探讨如何避免十二指肠损伤的漏诊。方法：回顾性分析我院450例腹部外伤中漏诊的8例十二指肠损伤病人处理和临床特点。结果：致伤原因以车祸伤为主(6例)，复合伤6例，术前无一例正确诊断为十二指肠伤，所有病例均行手术治疗，6例治愈，死亡2例，死亡原因为严重感染及多器官功能衰竭。漏诊的主要原因为认识不足并缺乏相应的特殊检查。结论：对有严重上腹外伤史者，应高度警惕十二指肠损伤，反复的物理检查，动态的辅助检查尤其是CT检查，及时剖腹探查等可减少十二指肠损伤的漏、误诊率。     

Factors affecting outcome in pancreatic trauma

Reported mortality from pancreatic trauma remains at approximately 20% and morbidity is about 33%. A recent series was reviewed to highlight unresolved problems associated with this injury. From 54 consecutive patients treated operatively for pancreatic trauma during a recent 7-year period, 44 patients were evaluated. Among these 44, six died and 12 developed fistulas and/or abscesses. Of those who died, four had colon injuries and two had duodenal injuries, one of whom had combined colon and duodenal injuries. Patients with colon injuries also had a higher incidence of intra-abdominal abscesses and fistulas. Indeed, colon injury currently may be the most significant factor causing morbidity and mortality in cases of pancreatic trauma. Despite improved management of duodenal injuries, morbidity and mortality rates for these patients also remain high. Twenty-six patients went into shock before the end of their operation, and all six deaths occurred in this group. The mean number of intra-abdominal associated organ injuries was 2.1 per patient; complications and deaths were directly related to these injuries.     

闭合性十二指肠损伤的治疗

目的 进一步提高闭合性十二指肠损伤的早期诊断及其相应手术方式的选择。方法 总结1989年3月至1999年12月收治的10例闭合性十二指肠损伤病例的临床资料。均行手术治疗。其中行十二指肠浆膜切开血肿清除术2例，十二指肠修补术2例，损伤肠段切除吻合术2例，十二指肠空肠Roux-Y吻合术2例，十二指肠憩室化1例，十二指肠造口减压术1例。结果 全部治愈，无死亡及明显并发症发生。结论 早诊断、早手术是闭合性十二指肠损伤治疗的关键，同时选择适宜的手术方式对降低病死率和提高远期生活质量很重要。     

Traumatic duodenal hematoma in the pediatric patient

Twenty children with duodenal hematomas secondary to blunt trauma were treated between 1953 and 1983. The duodenal injury was isolated in ten cases and associated with intra-abdominal injuries in the others. In ten, the duodenal injury was suspected on admission and the diagnosis was confirmed within 24 hours by radiographic contrast studies. All ten were managed successfully with nasogastric suction and intravenous fluids. Ten patients underwent laparotomy for increasing abdominal tenderness and guarding. An isolated duodenal hematoma was found in four and treated by evacuation and/or gastroenterostomy. In five of the remaining six surgical patients, all of whom had multiple intra-abdominal injuries, the duodenum was left untouched. Three of these patients had postoperative contrast studies that showed early resolution of the duodenal hematoma. No duodenal stricture or leak developed in any patient. The children with isolated duodenal hematomas who were treated conservatively had a mean hospital stay of six days, whereas those treated surgically had a mean stay of 17 days. The ten patients with multiple intra-abdominal injuries had a mean hospital stay of 32 days. In this group, eight required total parenteral nutrition or nasojejunal feeds for nutritional support. In these patients, an isolated duodenal hematoma resulted in minimal morbidity and nonoperative management was usually successful. The presence of associated intra-abdominal injuries was responsible for the prolonged hospitalization and delayed return of normal intestinal function in some patients.     

腹腔镜胆囊切除术中消化道损伤原因及处理

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中消化道损伤的原因、处理方法及预防措施。方法回顾分析2000年1月～2007年12月我院21640例LC术中16例（0.07%）消化道损伤的临床资料,其中胃十二指肠损伤14例,结肠损伤1例,回肠损伤1例。结果术中发现13例：行镜下修补3例,中转开腹修补7例、胃大部切除胃空肠Roux-en-Y吻合3例。术后发现3例：开腹回肠修补1例,结肠造瘘1例,引流保守治疗1例。除1例因十二指肠漏并多器官功能衰竭（MODS）术后7天死亡,其余15例均治愈出院,无严重并发症出现。结论LC中消化道损伤的主要原因是胆囊周围炎性粘连,暴露不良,分离过程中造成胃肠撕裂,灼伤穿孔。及时有效恰当的处理是预防并发症和改善患者预后的关键。