十二指肠损伤的处理

The Treatment of Duodenal Injury

目的:探讨十二指肠损伤的常见原因及外科处理方法。方法:收集1988年6月至2000年12月我院收治的8例十二指肠严重损伤患者的临床资料,回顾性分析十二指肠严重损伤的原因及外科处理方式。结果:本组8例十二指肠严重损伤,主要的损伤原因为车祸和医源性损伤,均经十二指肠破口与空肠直接行Roux-en-Y吻合,术后恢复顺利,痊愈出院。除1例3.5年后肿瘤复发死亡外,其余病人无并发症及后遗症。经以往各种手术相比较,十二指肠破口与空肠直接Roux-en-Y吻合效果最好。结论:十二指肠损伤常见的原因是车祸和医源性损伤,因十二指肠位置特殊,缺乏典型的临床症状,早期诊断困难。应及早诊断,根据患者发病机制、临床表现、辅助检查及术中探查选择简单而合理的手术方式可提高其治愈率。十二指肠破口与空肠直接行Roux-en-Y吻合,该手术方法简单,创伤轻,疗效好,而且适应于十二指肠各部位的损伤。

Objective： To discuss the common causes and surgical treatment of duodenal injury. Methods： The clinical data of 8 patients with duodenal injury that we had diagnosed and treated were collected in the department of general surgery of our hospital from June 1988 to December 2000. A retrospective analysis was conducted including the causes and surgical treatment of serious duodenal injury. Results： 8 cases of patients with serious duodenal injury were cured by Roux-en-Y. The causes were traffic accident damage and iatrogenic injury. 7 of them recovered very well and they had few complications and sequels. One patient died from the recurrence of tumor atter 3.5 years. There was a better effect that having an operation on duodenum wound and jejunum by Roux-en-Y compared with all sorts of operation in the past. Conclusion： The causes of duodenal injury were traffic accident damage and iatrogenic injury. Because the specific symptoms, and characteristic for duodenal damages are absent, the diagnosis is often delayed. The anatomical location of the duodenum also makes diagnosis and treatment of isolated duodenal injury a difficult task. The mechanism of injury （acceleration and deceleration impact）, upper abdominal tenderness with tachycardia, raised temperature and vomiting should warrant further evaluation. We should diagnose the diease according to the mechanism of injury and potential causes as soon as possible. The choice of surgical procedure depends on the degree and site of the injury, and several surgical treatment options can be considered for duodenal injury according to the severity of the injury. In addition, if we choose a simple and reasonable surgical method, it will have a better effect and higher cure rate. Roux-en-Y has a simple, less traumatic, and better curative effect. It is appropriate for any parts of the duodenal injury.