十二指肠憩室的外科治疗

Surgical treatment of duodenal diverticulum

目的探讨十二指肠憩室外科治疗的适应证和术式选择。方法对本医院1990年7月-2005年10月间收治的40例患者的临床资料进行回顾性分析。结果本组患者30-60岁居多,平均58.5岁。合并有较重的憩室炎、憩室出血、憩室穿孔、十二指肠梗阻、胆管炎或胰腺炎等症状。30例采用憩室旷置、胃大部切除、Billroth II氏吻合术,1例行憩室内翻缝合术,胃-空肠、十二指肠-空肠及胆总管-空肠Roux-en-Y吻合术各2例,憩室切除术3例中同时行Oddi氏括约肌切开成形术1例,另2例出现严重并发症死亡。33例获得随访,时间3-14年,临床疗效良好率达86.84%(33/38)。结论本病的外科治疗必须在有适应证的前提下由有胆胰十二指肠手术经验的医师施行。憩室旷置、胃大部切除、Billroth II氏吻合术应作为基本术式,疗效满意。

Objective To evalute the indications and surgical procedures for duodenal divreticulum.Methods Clinical data of 40 cases with duodenal diverticulum in our hospital from July 1990 to October 2005 were analyzed retrospectively.Results Most patients were 30-60 years old and the average were 58.8 years. These patients received surgical treatments because of severe symptoms such as diverticulitis、 Diverticulum hemorrhage、Diverticulum perforation、 Duodental obstruction、Complicated cholangitis or pancreatitis, etc. 30 patients received exclusion of duodenal diverticulum and Billroth II subtotal gastrectomy, 1 patient recovered after diverticulum inverting suture, 6 patients recovered after Gastrojejunostotomy、duodenojejunostotomy and choledochojejunostomy. 3 patients received diverticulectomy, among them 1 patient recovered with Sphincteroplasty of oddi, 2 patients died of severe complications. 33 patients were followed-up from 3 to 14 years and the total clinical effective rate reached 86.84%.Conclusion Surgical treatment of duodenal diverticulum must be performed by surgeons with the experiences of biliary and pancreatoduodenal operations under indication. Exclusion of duodental diverticulum and Billroth II subtotal gastrectomy is a fundamental procedure.