35例闭合性十二指肠损伤的早期诊断分析

目的:探索闭合性十二指肠损伤患者早期诊断方法,以提高十二指肠损伤的早期确诊率,降低患者手术并发症发生率和死亡率。方法:采用作者所建腹部外伤数据库,收取广州南方医院、宁夏银川解放军第五医院1995～2006年收治十二指肠损伤患者35例,对其早期诊断方法、诊断结果及漏诊、误诊原因进行回顾性分析。结果:术前13例(37.1%)患者剖腹前得到明确诊断;22(62.9%)例患者术前首诊漏诊,其中19例(54.3%)患者剖腹探查术后确诊,3例(8.6%)患者首次剖腹探查术后仍漏诊。结论:十二指肠损伤发病率低,漏诊率高,术前诊断困难,术中仍易被漏诊。行腹腔穿刺及CT、口服泛影葡胺造影、腹部X光片及腹部B超检查的综合应用有利于明确诊断,可减少术后并发症,降低死亡率的发生。

Objective:To explore the early diagnosis of traumatic rupture of Closed duodenal injury.To improve the accuracy of early diagnosis and cut the patient surgery complication formation rate and the mortality rate.Methods:The clinic datas of 35 patients with traumatic rupture of duodenum were retrospectively analyzed from 1995 to 2006 in guangzhou nanfang hospital and the 5th PLA hospital.To its early diagnosis method,the diagnosis result and leak examine,the error diagnostic reason to carry on the review analysis.Results:13 cases(37.1%)of duo-denal injury were diagnosed before the operation,22cases(62.9%)were misdiagnosis before operation,19 cases(54.3%)were proved during the operation.3 cases(8.6%)were misdiagnosis after operation.Conclusion:The traumatic rupture of Closed duodenal injury incidence rate is low,the rate of misdiagnosis is high,before the technique,diagnosed is difficulty,it was still easy to leak in operation,the abdominal puncture and CT,took orally the pan-shade Portugal amine radiography,the abdomen X-ray and the abdomen ultrasound inspection synthesis ap-plication are advantageous for diagnosos,reducing the complication of the operation and the mortality rate.