闭合性十二指肠损伤的诊治

The Diagnosis and Treatment of Closed Duodenum Injury

目的 探讨闭合性十二指肠损伤的诊治及其并发症的防治。方法 回顾性分析自 1985～2 0 0 0年间手术治疗闭合性十二指肠损伤的临床资料共 2 3例 ,术前确诊 5例 ;术中确诊 18例 ,其中 2例为第 2次剖腹探查术发现。行十二指肠单纯修补术 13例 ,十二指肠 -空肠Roux -en - y术 5例 ,十二指肠部分切除端端吻合术 1例 ,行Berne及Graham式十二指肠憩室化手术各 2例。均作鼻胃管十二指肠减压术 ,部分患者作三管引流术。结果 术后发生十二指肠瘘 2例 ,死亡 1例 ,膈下脓肿 1例 ,粘连性肠梗阻 3例 ,肺炎 2例。结论 闭合性十二指肠损伤术前诊断困难 ,术中易漏诊 ;早期诊断 ,选择合理术式可提高治愈率 ,减少并发症及死亡率。

Objective To discuss the diagnosis of closed duodenum injury and the prevention and treatment of its complications.Methods We retrospectively reviewed the clinical data of 23 cases of closed duodenum injury treated by operation during 1985～2000.Among the 23 cases,five cases were diagnosed before operation,eighting cases were diagnosed in operation,two cases were found in the second exploratory laparotomy.Single duodenum prosthesis was performed in 13 cases;the Roux-en-Y duodenojejunostomy was in 5 cases;partial duodenectomy and end-to-end anastomosis was performeol in one cases;Berne's and Graham's duodenum diverticular conversion was performed in 4 cases respectively.All patients were in nasogastric tube decompression,some was in tris-tube drainge.Results The cases of duodenal fistula,death,subphrenic abscess,adhesive ileus,and pneumonitis happened after operation was 2,1,1,3,2 respectively.Conclusions It is difficult to diagnose the closed duodenum injury before operation and easy to miss diagnosis during operation;early diagnoses and appropriate operation style can improve cure rate,decrease the complications and mortality.