十二指肠损伤的临床特点及术式探讨(附35例分析)

THE CLINICAL FEATURES AND DISCUSSION OF SURGICAL OPERATION FOR DUODENAL TRAUMA

目的探讨十二指肠损伤的临床特点及手术方法，以提高十二指肠损伤的诊治水平。方法回顾性分析３５例十二指肠损伤的诊断方法，及手术治疗结果。结果腹部Ｘ线透视、诊断性腹腔穿刺阳性率分别为３２．０％和１３．３％；腹膜外损伤占８５．７％，７１．４％的患者合并腹腔其他脏器损伤，术中漏诊率为１１．４％；术后并发症发生率及病死率分别为３７．１％和１１．４％。结论十二指肠损伤具有术前确诊率低、术中漏诊率高、合并损伤多的特点，因而病死率及并发症发生率均较高。及时手术，根据术中损伤情况选择合理的手术方式是提高治愈率，降低病死率的关键。

Objective To study the clinical features of duodenal trauma and its surgery to improve the level of diagnosis and treatment. Methods Methods of diagnosis and results of surgical treatment were analysed retrospectively of 35 cases of duodenal trauma. Results The positive rates of abdominal X-ray and abdominal puncture were 32. 0%, 13. 3% respectively. The extraperitoneal duodenal injuries occured in 30(85. 7 % ) cases. 25 (71. 4 % ) cases were complicated by additional intraabdominal organ injuries. The rate of failure to diagnose intraoperatively was 11. 4%. The postoperative complication rate was 37. 1 % and the death rate was 11. 4%. Conclusion Duodenal trauma is characteristic of low diagnostic rate preoperatively, high failure rate intraoperatively and most of the cases are complicated by other intraabdominal organ injuries, so both the complication and mortality are high. If the diagnosis is certain, surgery should been taken suitably. This is the key to improve prognosis. The procedure performed is based on the condition of duodenal injuries.