小儿十二指肠损伤的早期诊断和处理

The early diagnosis and management of the duodenal injury in children

目的探讨小儿十二指肠损伤的早期诊断和处理。方法回顾性分析2011年2月～2014年1月我院收治的6例小儿十二指肠损伤的临床资料。年龄2～10岁，中位年龄6岁，其中男4例，女2例。术前4例（66．7％）经上消化道及腹部cT检查明确，2例（33．3％）经术中明确。6例患者中5例均行十二指肠I期修补＋十二指肠旁引流术，1例行十二指肠空肠袢浆膜覆盖修补术，术后留置引流管。术后5例获得定期随诊。结果6例均顺利完成手术。术后1例出现肠漏，经胃肠减压、腹腔引流、胃肠道外营养等综合治疗后痊愈出院。5例患儿经半年以上随访无异常，1例失访。结论术前上消化道造影、B超和腹部cT检查对,＇bJL十二指肠损伤的早期诊断至关重要。早期手术干预有利于明确诊断并给予及时处理，治疗效果满意。

Objective To explore the early diagnosis and management of duodenal injuries in children. Methods A total of 6 cases of the duodenal injuries treated in our hospital from February 2011 to January 2014 were reported. The age ranged from 2 to 12, the median age was 6 years old. Of the 6 cases, there were 4 boys and 2 girls. Definite diag- nosis was confirmed by ultrasound and computer tomography （CT） in four patients （66.7%） before operation and 2（33.3%） during the operation. Five of the 6 patients received one-stage repair of duodenal rupture and periduodenal drainage. One patient underwent Jejunal serosal patch repair. Five patients were followed up regularly. Results All 6 operations were successful. One patient who suffered from duodenal leakage after the operation was received postoperative fasting, nasogastric decompression,nutritional support and drainage of the peritoneal cavity and was cured. In follow-up more than haft a year,no abnormality was identified in 5 patients in the postoperation and 1 was lost to follow up. Conclu- sion Preoperative upper gastrointestinal radiography, abdominal ultrasound and CT are crucial to early diagnosis of the duodenal injury. Early surgical intervention shows a beneficial effect on duodenal injuries.