CAJ | 학술논문

目的总结十二指肠损伤的诊断与治疗经验.方法回顾性分析1994年3月至2013年3月重庆市急救医疗中心收治的58例十二指肠损伤患者的临床资料,其中钝性伤47例,穿透伤11例.结合临床表现、影像学检查和腹腔穿刺术等明确损伤部位,采用美国创伤外科学会-器官损伤分级(AAST-OIS).根据患者病情及损伤范围等具体情况选择手术方式.采用门诊或电话随访,随访时间截至2013年9月.结果术前诊断17例,术中诊断41例.其中十二指肠损伤第一段7例,第二段28例,第三段17例,第四段6例;AAST-OIS Ⅰ级7例,Ⅱ级17例,Ⅲ级20例,Ⅳ级9例,Ⅴ级5例.58例患者行手术治疗,其中单纯缝合修补术23例,浆膜切开血肿清除、修补术4例,带蒂空肠片修补术7例,损伤肠管切除+端端吻合术5例,十二指肠空肠Roux-en-Y吻合术12例,胃空肠吻合术2例,合并胰头损伤行胰十二指肠切除术4例,十二指肠腔内外和胆总管、胰管广泛引流术1例.治愈48例,死亡10例,其中4例死于十二指肠损伤相关并发症;十二指肠狭窄、十二指肠瘘及腹腔脓肿是主要并发症.48例治愈患者中,6例失访,42例随访6～36个月,其中3例遗留轻度消化道不全梗阻症状,于术后6 ～12个月内消失;1例术后3个月发生胰十二指肠内瘘经保守治疗后痊愈;其余均正常.结论腹腔穿刺及CT等影像学检查是诊断十二指肠损伤的有效方法;治疗时应综合考虑肠壁损伤部位、范围等因素后选择简单合理的术式;有效的十二指肠减压和充分腹腔引流是手术成功的重要保障.
목적 총결십이지장손상적진단여치료경험.방법 회고성분석1994년3월지2013년3월중경시급구의료중심수치적58례십이지장손상환자적림상자료,기중둔성상47례,천투상11례.결합림상표현、영상학검사화복강천자술등명학손상부위,채용미국창상외과학회-기관손상분급(AAST-OIS).근거환자병정급손상범위등구체정황선택수술방식.채용문진혹전화수방,수방시간절지2013년9월.결과 술전진단17례,술중진단41례.기중십이지장손상제일단7례,제이단28례,제삼단17례,제사단6례;AAST-OIS Ⅰ급7례,Ⅱ급17례,Ⅲ급20례,Ⅳ급9례,Ⅴ급5례.58례환자행수술치료,기중단순봉합수보술23례,장막절개혈종청제、수보술4례,대체공장편수보술7례,손상장관절제+단단문합술5례,십이지장공장Roux-en-Y문합술12례,위공장문합술2례,합병이두손상행이십이지장절제술4례,십이지장강내외화담총관、이관엄범인류술1례.치유48례,사망10례,기중4례사우십이지장손상상관병발증;십이지장협착、십이지장루급복강농종시주요병발증.48례치유환자중,6례실방,42례수방6～36개월,기중3례유류경도소화도불전경조증상,우술후6 ～12개월내소실;1례술후3개월발생이십이지장내루경보수치료후전유;기여균정상.결론 복강천자급CT등영상학검사시진단십이지장손상적유효방법;치료시응종합고필장벽손상부위、범위등인소후선택간단합리적술식;유효적십이지장감압화충분복강인류시수술성공적중요보장.
Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with pancreaticoduodenal fistula were cured by conservative treatment at postoperative month 3 and the other patients were well survived.Conclusions Abdominal puncture and imaging examination such as CT are effective methods for the diagnosis of the duodenal injury.Surgical procedure selection should be based on the type and range of the injury.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.