十二指肠损伤的诊治及误诊分析

目的总结外伤性十二指肠损伤的诊断和治疗经验，减少误诊率。方法回顾性分析52例十二指肠损伤的临床资料。结果52例中单纯前壁损伤11例，十二指肠前后壁均损伤41例，52例中合并其他脏器损伤6例；全部手术治疗。治愈45例，死亡7例。手术探查漏诊5例，再次手术发现均有后壁对冲伤。结论十二指肠损伤多发生于车祸或腹部闭合性撞击伤，前壁的损伤常伴有后壁相应部位的对冲伤，由于后者损伤程度较前音为轻且隐蔽，甚至是非全层损伤，容易探查时漏诊和术后发生十二指肠漏。对可疑病例及早进行全面细致的手术探查、减少漏诊、误诊率、选择合理、恰当的术式是提高治愈率、降低并发症和病死率的关键。

The diagnosis and surgical treatment of duodenal trauma and the analysis of misdiagnosis

Objective To explore the diagnosis and surgical treatment of duodenal trauma. Methods A retrospective study was accomplished on the clinical data of 52 patients with duodenal trauma. Results Of 52 patients with duodenal trauma, 11 cases were simply anterior wall trauma, 41 cases were anterior and posterior wall trauma and 6 cases were complicated with other organs traumatic, All patients were treated by surgery, and 45 cases were cured and 7 cases died. Conclusions Duodenal trauma often betides when patients have suffered road accident or closed impact injury in abodomen. Anterior wall trauma is often complicated with contrecoup of corresponding posterior wall. The diagnosis of posterior wall trauma is easily missed and the leakage of duodenum often happens in the operation. It is critical to check the doubtful cases with careful operations research and select reasonable and appropriate operation types for the diagnosis and surgical treatment of duodenal trauma.