创伤性十二指肠损伤的诊治

目的:探讨创伤性十二指肠损伤的诊断及治疗方法。方法:回顾性分析27例十二指肠损伤患者采用十二指肠修补横行缝合关闭裂口、大网膜覆盖固定10例(其中包括合并小肠切除吻合2例,小肠破裂修补3例,肠系膜破裂修补2例),缝合修补加胃造瘘6例,十二指肠修补加胃造瘘和空肠造瘘3例,十二指肠修剪或部分切除后端端吻合2例,十二指肠修补加憩室化手术3例,十二指肠裂口与空肠Roux-en-Y型吻合术2例,胰十二指肠切除术1例。结果:27例患者有1例死于胰瘘和腹腔出血,病死率为3.7%,术后并发症发生率为25.9%。结论:十二指肠损伤漏诊率高,术前重视受伤特点、临床表现、完善检查,术中仔细探查是诊断的关键。

Study on diagnosis and treatment of duodenal trauma

Objective: To study the diagnosis and treatment of duodenal trauma.Methods: Clinical documents of 27 patients with duodenal injury were analyzed retrospectively.10 patients underwent duodenorrhaphy by suturing wound transversely and fixing and covering with major omentum(including small intestinal excision and anastomosis in 2 cases,small intestinal repair in 3 cases,splenectomy in 3 cases,mesentery repair in 2 cases).6 patients underwent duodenorrhaphy and gastrostomosis.3 patients underwent jejunostomy.2 patients underwent duodenoduodenostomy after clipping and partial resection.3 patients underwent duodenorrhaphy and diverticularization.2 patients underwent Roux-en-Y anastomosis between duodenal wound and jejunum.1 patients underwent duodenopancreatectomy.Results: One of the 27 patients died of pancreatic fistula and abdominal cavity bleeding,mortality was 3.7%,compared with previous data of the mortality of duodenal trauma,it decreased obviously.The incidence of postoperative complications was 25.9%.Conclusion: Miss diagnosis of duodenal trauma occurs frequently.To avoid it,preoperative examination should be done carefully and throughly,associating with the characteristics of trauma,clinical manifestations;in operation,attentive probe of the duodenum is significant.