医源性十二指肠损伤14例原因分析及处理

回顾分析2000年1月至2010年1月我院及外院转入共14例医源性十二指肠损伤患者的临床资料。14例中，术中发现9例，即刻行修补或附加空肠造口内、外引流术，均痊愈；术后〈24h发现2例，1例痊愈，1例术后低流量十二指肠瘘经保守治疗痊愈；术后24～72h发现2例，再次手术后均死亡；1例术后7d才发现者来院时已感染性休克，抢救无效，4h后死亡。提示，十二指肠损伤术中发现者，经妥善处理预后佳；术后早期（〈24h）发现且能正确处理，预后较好；超过48h者预后差。

Iatrogenic duodenal injuries and treatment: a report of 14 cases

Clinical data of 14 patients with iatrogenic duodenal injuries treated in hospital from January 2000 and January 2010 were retrospectively reviewed.Iatrogenic duodenal injuries were found intraoperatively in 9 cases,in whom repair or additional jejunostomy was performed and all were cured and discharged.In 2 patients the duodenal injuries were found within 24 hours postoperatively,1 was cured,another had low flow duodenal fistula and cured with conservative treatment.Duodenal bypass and extraoral drainage were performed in 2 patients whose duodenal injuries was found 72 hours after surgery and died from severe infection of retroperitoneal space and multiple organ failure respectively.One patient whose duodenal injury was found 7 d postoperatively suffered from septic shock and died in 4 h after admission.The results suggest that early detection and early management would result in satisfied outcome for patients with iatrogenic duodenal injuries,the first 24 hours are crucial.