十二指肠憩室手术治疗42例分析

Surgical treatment of duodenal diverticulum:An analysis of 42 cases

目的：探讨十二指肠憩室定位性诊断和术式选择。方法：用胃肠钡餐、低张钡十二指肠或胆道造影、内窥镜、术中十二指肠内充气等方法，确定憩室形态、大小和部位后，行内翻、切除、胃肠转流或胰十二指肠切除术。结果：４２例中，１例肠瘘，１例肝硬化出血、腹水死亡，１例胰胆瘘、２例胃肠转流吻合口梗阻再手术治愈，其他患者效果满意，总治愈率９５．２４％。结论：切除憩室是根治的基础，旷置胃肠转流也是可取性术式，但胰十二指肠切除一般不选用。

Objective:To investigate the method of topographic diagnosis and surgical treatment of duodenal diverticulum.Methods:In 42 cases with duodenal diverticulum,barium meal for low tense duodeno or cholangiography,endoscopy,and duodenal gas inflation during operation were performed to determine the shape,size and location of the diverticulum.Surgical techniques,including inversion or removal of the involved lesion,gastroenterostomy or pancreatoduodenectomy were used for treatment.Results:The results of treatment were satisfactory in most of cases,with exception of intestinal fistula in 1,death from hemorrhage,and ascites due to cirrhosis of liver in 1,pancreas bile duct fistula in 1,and anastomotic obstruction after gastroenterostomy in 2.The overall cure rate was 95.24%.Conclusions:Removal of the diverticulum is essential,gastroenterostomy is suggestive,while as pancreatoduodenectomy is not recommended.