十二指肠损伤诊治的经验和教训

Experience and lesson in the diagnosis and treatment of duodenal injury

目的 提高十二指肠损伤的早期诊断率和选择合适的治疗方法。方法 总结１９８３ 年１ 月至１９９８年１２ 月收治的１７ 例十二指肠损伤患者的临床资料。多为严重多发伤，致伤原因以车祸伤为主，全部经手术治疗。行十二指肠修补术１１ 例，十二指肠改良憩室化手术４ 例，改良憩室化再简化术和十二指肠ＲｏｕｘｅｎＹ 吻合术各１ 例。结果 治愈１４ 例，死亡３ 例。致死原因为十二指肠瘘和多器官功能障碍综合征。十二指肠瘘和腹腔脓肿是主要的并发症。结论 十二指肠损伤早期诊断和及时手术处理是非常重要的。改良十二指肠憩室化和十二指肠修补术是比较实用的手术方法。

Objective To increase the accuracy of early diagnosis and decrease postoperative complications, and to choose a suitable management of duodenal injury. Methods 17 patients with duodenal injury were treated from January, 1983 to December, 1998 in Zibo Municipal Central Hospital. The most of them were multiple injuries. The main cause of injury was traffic accident. All patients were treated by operation, 11 patients with primary repair, 4 cases with Cogbill's techniques for diverticularization, one with modified Cogbill's method and one Roux en Y duodenojejunostomy, respectively. Results 14 patients were cured successfully, 2 died from the duodenal fistula and 1 multiple organ dysfunction syndrome. The main complications were fistula and intra abdominal abscess. Conclusion It is very important that the early diagnosis and treatment in time for duodenal injury. The primary repair and Cogbill's techniques for diverticularizations are practical.