外伤性十二指肠损伤的早期诊断及外科处理

Early Diagnosis and Surgical Treatment of the Duodenal Injury

目的 探讨十二指肠损伤的早期诊断及选择简单而合理的手术处理方式。方法 通过分析 1991年～ 2 0 0 3年 16例十二指肠损伤的临床资料进行经验总结。结果 治愈 15例 ,死亡 1例 ,十二指肠瘘 3例 ,胰瘘 2例 ,腹腔脓肿 2例 ,经换药及B超定位下腹腔穿刺引流治愈 ,未发现远期并发症。结论 十二指肠损伤的早期诊断与及时手术处理是非常重要的。十二指肠修补和改良的十二指肠憩室化手术是比较实用的 ,有效的十二指肠引流及术后肠外营养支持是影响预后的主要因素。

Objective To investigate the accuracy of early diagnosis and choose a suitable surgical treatment for duodenal injury. Methods Clinical data of 16 cases of duodenal injury from Jan 1991 to Jan 2003 were collected and retrospectively analysed. Results In this group 15 cases were cured, and 1 case died, complications occurred in 7.Three cases were complicated with duodenal fistula,two with pancreatic fistula, tow with intra-abdominal abscess. All this patients were cured by the ultrasound-guided abdominal dranige through fine-needle aspiration, no long-term complication. Conclusion The early diagnosis and treatment in time of duodenal injury are importment.The primary repair and Cogbills technigues for diverticuarization are pratical.Effective decompression of the duodenum and post operative parenteral nutrition are the major prognostic factors.