十二指肠损伤的诊治探讨

Analysis of Diagnosis and Treatment of Duodenal Injuries

目的:探讨十二指肠损伤的诊断,特别是早期诊断,手术时机及治疗方法。方法:对十二指肠损伤的早期临床症状,体征,处理方法及造成死亡的原因进行分析。结果:26例均进行手术治疗,治愈22例,死亡4例,死亡率15%,术后并发症8例,发生率31%(8/26)。结论:十二指肠损伤治疗成败的关键是掌握好早期手术探查指征和选择合适的术式。对损伤严重者修补加空肠贴补及改良憩室化再简化手术联合应用为一种较理想的处理方法。导致病人死亡的主要原因是误诊和漏诊以及术式选择不当引起肠瘘、感染和出血。

Objective ：To explore the diagnosis, especially the early diagnosis , the opportunity of operation and the treatment of duodenal injuries. Method： The early clinical signs and characters, the treatment and cause of deaths in 26 cases of duodenal injuries were studied retrospectively. Result： All the 26 cases underwent surgical treatment, among the 26 cases,22 were cured,4 died after operation and 8 occurred post operative morbidity, the mortalyty rate was 15%, and the postoperative morbidity rate was 31% （8/24 ）. Conclusion： Succesive treatment of duodenal injuries depends on mastering early explorative indications of operation and selecting proper surgical management, the combination of primary repair with jejunal serosal patch and simplified duodenal diver ticulation is a good choice of surgical treatment, the cause of death include preoperative and postoperative misdiagnosis, and improper operation which cause intestinal fistulas, infection and bleeding.