创伤性十二指肠损伤的临床诊治分析  

Clinical diagnosis and treatment of traumatic duodenal injury

作　　者：王谦 张弛 金圣杰 蒋国庆 柏斗胜 WANG Qian;ZHANG Chi;JIN Shengjie;JIANG Guoqing;BAI Dousheng(Department of Hepatobiliary Surgery,the Northern Jiangsu People’s Hospital,Yangzhou,Jiangsu 225000,China)

机构地区：[1]扬州大学临床医学院/苏北人民医院肝胆外科,江苏扬州225000

出　　处：《肝胆胰外科杂志》2023年第8期479-482,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨创伤性十二指肠损伤的诊疗要点和难点,总结诊断思路及治疗体会。方法回顾性分析江苏省苏北人民医院普通外科2012年1月至2021年8月收治的14例十二指肠损伤患者的临床资料。14例患者均为闭合性腹部外伤致十二指肠损伤,单纯十二指肠损伤6例,复合型损伤8例;其中合并多发性肋骨骨折2例,肺挫伤2例,肝破裂2例,胰腺挫伤3例,脾破裂1例,右肾血肿1例,肠管损伤2例,胆总管下端损伤1例。结果术前CT影像学确诊十二指肠损伤12例,术中探查确诊2例。1例行保守治疗,7例行十二指肠修补术,5例行十二指肠憩室化手术,1例行胰十二指肠切除术。1例术后主动要求转院,其余13例患者平均住院时间(24.7±15.1)d。术后发生并发症3例,其中胃瘫、胰漏、腹腔感染致脓肿各1例,均保守治疗后痊愈出院。结论对于创伤性十二指肠损伤患者,若术前存在有腹痛等腹部体征,CT检查提示后腹膜后有散在气体,则需要进行剖腹探查。及时的早期诊断和手术,适合患者的手术方式,有效的腹腔引流和胃十二指肠腔内减压是患者良好预后的关键。Objective To investigate the key points and difficulties in the treatment of traumatic duodenal injury,and to summarize the clinical experience.Methods The clinical data of 14 patients with traumatic duodenal injury treated in Northern Jiangsu People’s Hospital from Jan.2012 to Aug.2021 were retrospectively reviewed.Among the 14 patients,there were 6 patiens with isolated duodenal injuries and 8 patiens with composite-type injuries,which included multiple rib fractures(n=2),pulmonary contusion(n=2),hepatic rupture(n=2),pancreatic contusion(n=3),splentic rupture(n=1),right renal hematoma(n=1),intestinal injury(n=2)and bile duct injury(n=1).Results Among the 14 patients,12 patients were diagnosed by preoperative CT imaging and the other 2 patients were confirmed by intraoperative exploration.One patient received conservative treatment,7 patients underwent duodenal repair,5 patients underwent duodenal diverticulization,and 1 patient underwent pancreaticoduodenectomy.One patient was automatically transferred to other hospital after surgery.Average hospitalization time of the other 13 patients was(24.7±15.1)d.Postoperative complications occurred in 3 patients,including 1 case of gastroparesis,1 case of pancreatic leakages and 1 case of intra-abdominal abscesses.These complications were successfully treated with conservative measures and the patients were discharged.Conclusion In treatment of traumatic duodenal injury,reliable indications for laparotomy include abdominal pain and detection of free gas in the retroperitoneum preoperation by CT.Timely early diagnosis,appropriate treatment strategies,as well as effective abdominal drainage and cavity decompression in gastroduodenal,are important process in ensuring the recovery of the patient.

关 键 词：创伤和损伤 十二指肠疾病 早期诊断 手术方式 

分 类 号：R656.6[医药卫生—外科学]