胃造口双管法在十二指肠破裂修复术中的临床应用  

Application of double-tube gastrostomy in the repair of duodenal rupture

作　　者：艾涛[1] 高劲谋[2] 胡平[2] 赵山红[2] 马渝[2] 周发春[1] 

机构地区：[1]重庆医科大学附属第一医院急诊科,400016 [2]重庆市急救医疗中心,400014

出　　处：《中华消化外科杂志》2016年第3期266-270,共5页Chinese Journal of Digestive Surgery

摘　　要：目的探讨胃造口双管法在外伤性十二指肠破裂修复术中的应用价值。方法采用回顾性队列研究方法。收集2005年1月至2015年1月重庆市急救医疗中心收治的41例行十二指肠破裂修补术患者的临床资料。2005年1月至2009年12月收治的25例患者十二指肠减压和空肠营养管放置方法采用Hassan三管法设为三管组，2010年1月至2015年1月收治的16例患者采用胃造口双管法设为双管组。患者采用十二指肠破裂缝合修补、带蒂空肠片以及十二指肠端一端吻合的方法行十二指肠修复术。患者术后予以抗感染、抗休克、生长抑素抑制分泌、营养支持及防治并发症等常规治疗。术后48h开始经肠内营养管泵注营养液500mL／d，渐进性增加泵注量并逐步过渡到全肠内营养支持治疗，同时收集引流的消化液回输入营养管。观察两组患者术中情况：手术方式、手术时间、术中出血量。术后情况：并发症（十二指肠瘘、腹腔感染、切口感染、肺部感染、肠梗阻）、营养管拔除时间及住院时间。正态分布的计量资料以孟±s表示，组问比较采用独立样本t检验。计数资料比较采用χ^2检验或Fisher确切慨率法检验。结果41例患者中行十二指肠破裂缝合修补术28例、带蒂空肠片修补术8例、十二指肠端一端吻合术5例；患者术中均行十二指肠减压及放置空肠内营养管。三管组患者手术时间为（184±38）rain，双管组为（153±37）min，两组比较，差异有统计学意义（t=2．566，P〈0．05）。三管组和双管组患者术中出血量分别为（1112±707）mL和（1011±595）mL，两组比较，差异无统计学意义（t=0．476，P〉0．05）。三管组和双管组患者术后十二指肠瘘、腹腔感染、切口感染、肺部感染发生比例分别为3／25和1／16、8／25和5／16、9／25和4／16、10／25和6／16，两组患者上述指标比较，差异均无统计学意义（χ^2Objective To investigate the application value of double-tube gastrostomy in the duodenal rupture repair. Methods The retrospective cohort study was adopted. The clinical data of 41 patients who underwent duodenal rupture repair at the Chougqing Emergency Medical Center from January 2005 to January 2015 were collected. Twenty-five patients using Hassan triple-tube gastrostomy technique between January 2005 and December 2009 were divided into the triple-tube （TF） group and 16 patients using double-tube gastrostomy technique between January 2010 and January 2015 were divided into the double-tube （DT） group. Duodenal rupture repair included suture repair, pedieled ileal flap to repair duodenal defect and end to end anastomosis. Patients underwent the regular treatments of anti-infection, antishock, somatostatin inhibition, nutritional support and complications prevention. Patients were injected with 500 mL/d nutrient solution using enteral nutritional tube from 48 hours after operation, and then dosage was gradually increased to total enteral nutrition and digestive juices collected from drainage fluid were transfused to enteral nutritional tube. The postoperative complications （ duodenal fistula, intraperitoneal infection, incision infection, pulmonary infection and intestinal obstruction）, operation method, operation time, volume of blood loss, enteral nutritional tube removal time and duration of hospital stay were observed. Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using an independent sample t test. Comparison of count data was analyzed using chi-square test or Fisher exact probability. Results All the 41 patients underwent duodenal rupture repair, including 28 using suture repair of duodenal rupture, 8 using pedicled ileal flap to repair duodenal defect and 5 using end to end anastomosis, with the intraoperative duodenal decompression and placement of intestinal feeding tube. The operation time was （184 ± 38）minutes in the TY

关 键 词：十二指肠损伤 外科手术 减压 营养支持治疗 

分 类 号：R656.64[医药卫生—外科学]