十二指肠损伤35例外科治疗体会

Operative therapy to 35 duodenal injuries

目的:探讨十二指肠损伤的外科治疗手术方式及效果。方法:回顾分析1998年3月—2008年3月手术治疗的35例十二指肠损伤患者的临床资料。结果:十二指肠损伤术前诊断率低,为17.1%(6/35);合并其他脏器损伤率高,占71.4%(25/35)。手术方式:单纯修补造瘘10例,端端吻合或与空肠侧侧吻合3例,十二指肠空肠Roux-en-Y吻合3例,浆膜覆盖及带蒂空肠片移植修补8例,十二指肠憩室化手术8例,胰十二指肠切除3例。十二肠损伤术后并发症发生率及死亡率较高,本组死亡5例(14.3%)。结论:十二指肠损伤的外科处理关键应根据其损伤情况综合判断,选择合理术式及治疗策略。

Objective：To discuss the surgical manners and effects of duodenal injuries.Methods：Retrospectively analyze 35 duodenal injuries who received surgical treatments from March 1998 to March 2008 in our department.Results：The diagnosis rate of duodenal injury preoperatively was low to 17.1%（6 patients）,and the incidence rate of associated injury was high to 74.1%（25 patients）.The surgical procedure of ten patients was simply neoplasty and fistulation;three were end-to-end anastomosis or jejunal side-to-side anastomosis;three was Y-shaped Duodenojejunostomy;eight was serous membrane covering and pedicled jejunal slice grafting;eight was duodenal diverticularization;three was pancreaticoduodenectomy.The postoperative complications rate and mortality were high in duodenal injuries.Five patients were dead in our group（14.3%）.Conclusions：The key point of the surgical therapy to duodenal injuries is judging comprehensively by the injury status and choosing the optimal surgical mannerand therapeutic strategy.