闭合性十二指肠损伤再手术分析

Analysis of factors and managements of reoperation in blunt duodenal trauma

目的探讨闭合性十二指肠损伤再手术的原因及处理方法。方法对2011年1月至2013年12月收治的15例闭合性十二指肠损伤再手术病例临床资料进行回顾性分析。结果再手术原因:十二指肠瘘10例(误诊、漏诊各1例),腹膜后脓肿2例,十二指肠瘘、腹膜后脓肿2例,腹腔出血1例。10例单纯十二指肠瘘患者行十二指肠修补及憩室化、双套管引流术,其中6例一期治愈,3例腹膜后脓肿,经清创、双套管引流术后治愈,1例十二指肠瘘,经双套管引流后二期治愈。2例十二指肠瘘、腹膜后脓肿及2例单纯腹膜后脓肿患者均经清创、双套管引流术后一期治愈。1例腹腔出血患者探查止血,术后3天死于MODS。15例患者均经鼻肠营养管给予肠内营养治疗。结论准确的早期诊断、仔细的术中探查、及时简单合理的手术方式修补十二指肠损伤、有效的腹腔灌洗引流、合理的营养支持策略是治疗闭合性十二指肠损伤再手术的主要处理措施。

Objective To investigate the factors leading to reoperation and management in blunt duodenal trauma. Meth- ods Clinical data of 15 eases of reoperation in the duodenal trauma from Jan 2011 to Dec 2013 were collected and retro- spectively analyzed. Results The reasons for the reoperation were： 10 duodenal fistula（ 1 delayed diagnosed and 1 not found during the first operation） ,2 retroperitoneal abscesses ,2 duodenal fistula and retroperitoneal abscesses and 1 hem- orrhage. 10 patients with duodenal fistula were treated by primary repair, duodenal diverticularization and catheterization with no death and 4 complications （3 retroperitoneal abscess treated successfully by a debridement and catheterization, 1 duodenal fistula treated successfully by catheterization）. The patients with retroperitoneal abscesses（ n = 2）and duodenal fistula and retroperitnneal abscesses （n = 2 ）underwent successfully a debridement and catheterization. 1 patient with hem- orrhage underwent a debridement for hematischesis and died. Enteral nutrition applied 15 patients by a naso - intestinal feeding tube. Conclusion Simple and reasonable surgical procedure, effective peritoneal lavage and drainage, reasonable strategy of nutritional support are very important for duodenal trauma.