创伤性十二指肠损伤患者的外科诊疗分析  

Analysis of surgical treatment of traumatic duodenal injury

作　　者：茹皓 阔文蕾 刘畅[1] 董泽鹏 孙学军[1] 孙祺 RU Hao;KUO Wenlei;LIU Chang;DONG Zepeng;SUN Xuejun;SUN Qi(Department of General Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an,Shaanxi 710061,P.R.China)

机构地区：[1]西安交通大学第一附属医院普通外科,西安710000

出　　处：《华西医学》2024年第11期1714-1717,共4页West China Medical Journal

基　　金：国家自然科学基金(82073271)。

摘　　要：目的 探讨闭合性腹部损伤中十二指肠损伤的外科治疗方法及其疗效。方法 回顾性收集西安交通大学第一附属医院2014年12月-2023年8月收治的行外科治疗的创伤性十二指肠损伤患者的临床资料,从受伤原因、诊断方法、外科治疗方法、疗效、并发症等方面进行分析。结果 共纳入患者8例。其中,男7例,女1例;年龄17~66岁,平均(44.4±19.3)岁;交通伤5例,重物撞击伤2例,高处坠落伤1例;球部损伤1例,降部损伤3例,水平部损伤3例,降部合并水平部损伤1例;美国创伤外科协会十二指肠损伤分级Ⅱ级损伤5例,Ⅲ级损伤2例,Ⅳ级损伤1例。所有患者术前均行CT检查,其中2例术前经CT直接诊断十二指肠损伤,其余病例皆由术中探查确诊。所有患者均行手术治疗,其中行胰十二指肠切除术4例,十二指肠修补术和胃空肠吻合术2例,十二指肠修补术和空肠造瘘术1例,肠系膜上静脉修补、胰腺坏死组织清除和腹腔置管通畅引流术1例。1例患者于术后9 d出现肠瘘,予以二次手术;1例患者于损伤控制术后复苏阶段死于多器官功能衰竭;3例患者并发腹腔感染,予以抗感染治疗后痊愈。结论 创伤性十二指肠患者早期临床表现不典型,影像学表现不明显,对于怀疑有十二指肠损伤的外伤患者应进行密切的生命体征监测,在生命体征平稳前提下积极进行探查手术,明确损伤部位并进行合理手术,术后应当进行充分的肠内减压与引流。Objective To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma.Methods Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected.The injury causes,diagnostic methods,surgical treatment methods,curative effect,and complications of patients were analyzed.Results A total of 8 patients were included.Among them,there were 7 males and 1 female.The age ranged from 17 to 66 years old,with an average of(44.4±19.3)years old.There were 5 cases of traffic accident injury,2 cases of crush injury,and 1 case of falling injury.There was 1 case of duodenal bulb injury,3 cases of descending part injury,3 cases of horizontal part injury and 1 case of both descending and horizontal injuries.According to the scale of American Association for the Surgery of Trauma for duodenal trauma,there were 5 cases of gradeⅡinjury,2 cases of gradeⅢinjury,and 1 case of gradeⅣinjury.All patients underwent CT scan,of which 2 cases were directly diagnosed with duodenal injuries by CT,and the remaining cases diagnosed by intraoperative exploration.All patients underwent surgical treatment,including 4 cases of pancreaticoduodenectomy,2 cases of duodenal repair and gastrojejunostomy,1 case of duodenal repair plus jejunostomy,and 1 case of superior mesenteric vein repair,pancreatic necrotic tissue removal,and abdominal catheterization for smooth drainage.One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery,1 died of multiple organ failure during the resuscitation phase after damage control surgery,3 developed intra-abdominal infection and cured by anti-infective treatment.Conclusions Early clinical manifestations of traumatic duodenal injuries are atypical,and imaging findings might not be clear.For trauma patients suspected of having duodenal injury,rigorous vital sign monitoring is necessary.On

关 键 词：闭合性腹部损伤 十二指肠损伤 外科治疗 

分 类 号：R656.64[医药卫生—外科学]