原发性十二指肠损伤的诊断与术式选择

THE DIAGNOSIS AND OPERATIVE METHOD OF PRIMARY INJURY OF THE DUODENUM

目的 探讨原发性十二指肠损伤的临床特点和选择合适的治疗方法。方法 对 1990 - 2 0 0 2年 10月收治经手术证实的原发性十二指肠损伤 2 2例作回顾性分析。单纯缝合修补、空肠逆行插管十二指肠减压及空肠造口术 6例 ,修补加空肠Roux -Y吻合术 10例 ,对端吻合并空肠逆行插管十二指肠减压及空肠造口、胆总管“T”型管引流术 2例 ,十二指肠憩室化手术 4例。结果 单纯十二指肠损伤 4例 ,合并伤 18例 (81 8% )共 2 8处 ;其中合并 2个脏器损伤 6例 ,3个脏器损伤 2例 ;治愈 2 0例 ,死亡 2例 (9 1% ) ;术后有并发症 6例 (30 % )。结论 掌握十二指肠损伤的临床特点 ,提高术中探查的确诊率 ,根据伤情选择合理的术式 ,十二指肠腔内彻底有效的减压引流 ,是减少并发症、提高治愈率的重要因素。

Objective To investigate the clinical characteristics and suitable operative method for primary injury of the duodenum. Methods\ Twenty-two cases with primary injury of the duodenum were analyzed and reviewed from 1990 to 2002. The operative methods were applied as following: 6 cases with simple suture for repair and decompression of duodenum via jejunum and jejunostomy; 10 cases with repair and jejunum Roux-Y anastomosis; 2 cases with additional “T' drainage of choledocho; 4 cases with operation for duodenal diverticulum. Results \ The classification of injuries as following: 4 cases with simple injury of duodenum; 18 cases with multiple injuries (81.8%). There were totally 28 injuries of duodenum. 6 cases with 2 visceral injuries and 2 cases with 3 visceral injuries. 20 patients were recovered after operation and 2 patients were died (9.1%). Complications were occurred in 6 cases (30%). Conclusion \ The key points for the prevention of complication and improvement of healing rate are : understanding fully the clinical characteristic of injuries of duodenum, rising the rate of definite diagnosis, selecting appropriate operative method, making total and effective decompression and drainage in duodenum cavity.