外伤性十二指肠破裂的诊治分析

目的：探讨外伤性十二指肠破裂的诊断和治疗方法.方法：回顾分析外伤性十二指肠破裂患者13例临床资料。结果：入院后3h内确诊6例,24～72h内确诊4例,72h后确诊3例。3例行十二指肠裂口修补,2例行十二指肠造瘘,2例行十二指肠空肠Roux-en-Y吻合,1例行十二指肠憩室化手术,1例行改良十二指肠憩室化手术,1例行十二指肠两断端关闭、胃空肠吻合,1例行十二指肠远端关闭、近端与空肠端侧吻合,2例行胰十二指肠切除术。术后6例（46.2%）出现切口感染、十二指肠瘘、消化道出血、胰瘘或腹腔感染等并发症,2例（15.4%）患者死亡,分别死于多器官系统衰竭和感染中毒性休克。结论：早期诊断与正确的术式选择是成功救治外伤性十二指肠破裂的关键。

Diagnosis and treatment of traumatic duodenal rupture

Objective To investigate the diagnosis and treatment of traumatic duodenal rupture.Method The clinical data of 13 patients with traumatic duodenal rupture hospitalized from May 1991 to December 2008 were retrospectively analyzed,and the material cause was automobile accident mainly.Results In these 13 patients,after hospitalization,6 cases were diagnosed in 3 hours,4 cases were diagnosed in 24～72 hours,and 3 cases were diagnosed after 72 hours.Three cases with duodenal cleft repair,2 cases with duodenal ostomy,2 cases with duodenum and jejunum Roux-en-Y anastomosis,1 case with duodenal diverticular surgery,1 case with meliorative duodenal diverticular surgery,1 case with duodenal broken ends closure and anastomosis of stomach with jejunum,1 case with duodenal distal closure and anastomosis of duodenal local with jejunum,and 2 cases with resections of pancreas duodenum.After the operation,6 cases(46.2%) appeared some complications of wound infection,duodenal fistula,digestive tract hemorrhage,pancreatic fistula,abdomen infection and so on.Two cases(15.4%) died from multiple system organ failure and septic shock.Conclusion The early diagnosis and correct operation style selection are the Keys for duodenal rupture.