外伤性十二指肠损伤15例临床分析  

Clinical analysis of 15 cases of traumatic duodenal injury

作　　者：张静 裴洁 李吉 徐月姣 郭跻 赵浩亮 何若冲 Zhang Jing;Pei Jie;Li Ji;Xu Yuejiao;Guo Ji;Zhao Haoliang;He Ruochong(Department of General Surgery,Shanxi Bethune Hospital,Taiyuan 030001,China;Department of Plastic Surgery,Shanxi Bethune Hospital,Taiyuan 030001,China;Graduate School of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西白求恩医院普通外科,太原030001 [2]山西白求恩医院整形外科,太原030001 [3]山西医科大学研究生学院,太原030001

出　　处：《中华全科医师杂志》2020年第10期938-941,共4页Chinese Journal of General Practitioners

摘　　要：回顾性分析山西白求恩医院普通外科2012年1月至2019年6月收治的15例外伤性十二指肠损伤患者的临床资料。其中闭合性损伤13例,开放性损伤2例。结合临床表现及影像学检查等明确损伤部位,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。其中术前诊断10例,术中诊断5例;AAST-OISⅠ级1例,Ⅱ级6例,Ⅲ级5例,Ⅳ级2例,Ⅴ级1例。15例患者均行手术治疗,行单纯修补1例,十二指肠造瘘引流术1例,十二指肠修补、胃部分切除、BillrothⅡ胃空肠吻合术5例,十二指肠修补、胆道减压、十二指肠减压术6例,胰十二指肠联合切除术2例。治愈15例,无死亡病例。3例患者发生术后并发症,术后并发症Clavien系统分级分别为Ⅲb级、Ⅱ级、Ⅱ级;1例出现十二指肠狭窄,系腹腔重度感染患者,术后6个月行胃部切除+BillrothⅡ胃空肠吻合术后痊愈,2例术后出现十二指肠瘘,经保守治疗后痊愈。术后门诊或电话随访,随访时间截至2020年2月,1例行胰十二指肠联合切除术的患者,治愈后在门诊随访6个月后因迁移至外地而失访,14例随访6~24个月。提示,对于怀疑十二指肠损伤的腹部急诊外伤患者,应积极行手术探查。治疗时应综合考虑肠壁损伤部位、范围等因素后选择合理的术式,术后及时应用肠内营养、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。The clinical data of 15 patients with duodenal trauma who were admitted to Shanxi Bethune Hospital from January 2012 to June 2019 were retrospectively analyzed.There were 13 patients with blunt injury and 2 with penetrating injury.The surgical procedure was selected by patient′s condition and extent of injury combined with the clinical symptoms,imaging examination 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 February 2020.Ten patients were diagnosed as duodenal trauma by CT scan before operation,and 5 patients were diagnosed during the operation.According to the AAST-OIS,1 patient was with gradeⅠinjury,6 in gradeⅡ,5 in gradeⅢ,2 in gradeⅣand 1 in gradeⅤ.All 15 patients received surgical treatment,including 1 with simple suture,5 with break suture and duodenal diverticularization,6 with break suture and biliary drainage(3 with hepatocystic duct drainage and 3 with cholecystostomy),2 with pancreaticoduodenectomy.Postoperative complications occurred in 3 patients with Clavien system classification ofⅢb,ⅡandⅡ.One patient with duodenal stricture and severe abdominal infection was cured after gastrectomy and BillrothⅡgastrojejunostomy 6 months after operation,and 2 cases with duodenal fistula were cured after conservative treatment.One patient who underwent pancreaticoduodenectomy was followed up for 6 months in the outpatient department,and 14 patients were followed up for 6-24 months.For emergency abdominal trauma patients with suspected duodenal injury,surgical exploration should be carried out actively.The site and range of intestinal wall injury should be considered in order to select a reasonable operation.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.Early postoperative enteral nutrition support is one of the key measures for successful wound healing.

关 键 词：十二指肠疾病 创伤和损伤 诊断 外科手术 肠道营养 

分 类 号：R656.64[医药卫生—外科学]