腹部手术中十二指肠损伤的预防和处理

Prevention and treatment of iatrogenic duodenum injury

目的探讨腹部手术中十二指肠损伤的发生原因和处理.方法回顾性分析了1995年1月～2004年12月所收治的15例医源性十二指肠损伤病例发生的原因和处理方法以及治疗结果.结果15例医源性十二指肠损伤病人中6例为胆囊切除术中十二指肠撕裂伤,3例为胆总管切开取石术中十二指肠穿通伤,4例为再次胆道手术中十二指肠撕裂伤,2例为结肠癌根治术中十二指肠撕裂伤.12例行单纯缝合修补,3例行'T'管引流及十二指肠损伤修补.术后3例发生十二指肠漏,其中2例治愈,1例死亡.结论加强手术医师责任心,提高手术水平是预防医源性十二指肠损伤的关键,在充分有效的十二指肠减压和腹腔引流条件下,绝大部分医源性十二指肠损伤可行单纯缝合修补.

Objective To investigate the occurrence and treatments of iatrogenic duodenum injury. Methods The causes, management and the therapeutic effectiveness of 15 cases of iatrogenic duodenum injuries from Jan. 1995 to Dec. 2004 were analyzed.Results In 15 patients with iatrogenic duodenum injuries, there were 6 cases of duodenum's laceration in cholecystectomy, 3 cases of duodenum's penetrating wound in choledocholithotomy, 4 cases of duodenum's laceration in the second biliary passage operation and 2 cases of duodenum's laceration in radical colectomy. Twelve cases only received single suture repair, 3 T-tube drainage and duodenum repair. Among 3 cases of duodeno-leaks happened after the operations, 2 cases were cured and one died.Conclusion Strengthening surgeons' responsibilities and improving the quality of surgeries is the key to prevent iatrogenic duodenum injury. Under the condition of valid decompression in duodenum and drainage in abdominal cavity, the majority of iatrogenic duodenum injuries can be cured by single suture repair.