十二指肠损伤的术式选择

The choice of surgical management for the patients with duodenal injury

目的探讨十二指肠损伤后手术方式的选择和手术效果。方法对本院１９８８～１９９８年１０年间手术治疗的３１例十二指肠损伤病人临床资料进行回顾性分析。结果①十二指肠损伤复合伤发生率高，合并其它脏器损伤者占７４％（２３例），其中合并胰损伤占２６％（８例）；②术前诊断率低，仅为１６％（５例）；剖腹探查中仍有３例（１０％）漏诊；③术式选择：单纯的十二指肠损伤以修补为主；十二指肠壁有缺损或合并有胰腺损伤，可采用浆膜覆盖术或十二指肠憩室化等其它手术；同时应有良好的十二指肠减压和腹腔引流；④术后并发症及死亡率发生率较高。本组死亡６例（１９％）；治愈２５例（８１％）。结论十二指肠损伤的修复应根据损伤的部位、损伤的严重程度、腹腔污染和合并伤的情况作综合考虑，选择合理的手术方式。

Objective To explore the choice and effect of surgical management of duodenal injury. Methods Retrospective analysis of the clinical data of surgical treatment of 31 patients was taken with traumatic duodenal injuries, who admitted to our department from 1988 to 1998. Results ① The rate of combined injuries in duodenal injury was high (23 cases, 74%), including pancreatic injuries in 8 cases (26%); ② The preoperative diagnosis rate was low (only 5 cases, 16%); even in the exploratory laparotomy, 3 cases were misdiagnosed. ③ The choice of surgical management as the following: a simple duodenal injury was treated with primary repair; Serosa cover methods or diverticulization technique was performed in patients with deficiency of the duodenal wall or combined with pancreatic injuries. Favorable duodenal decompression and drainage were importance; ④ The occurrence rate of complications and mortality were high after operation. In this series, six patients died (19%); 25 cases (81) were cured. Conclusions The choice of surgical treatment of duodenal injuries should be based on the location, type, severity and the contamination of the abdominal cavity to decrease the complications and mortality rate and improve the outcome as possible.