闭合性十二指肠损伤23例分析(1)
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【摘要】目的探讨闭合性十二指肠损伤的诊断。方法对23例闭合性十二指肠损伤诊断与治疗方法。结果根据腹部纯性损伤,右季肋部或背部肾区疼痛并逐渐加重,诊断性腹部穿刺(DPL)加腹部X光片,B超检查20例,DPL加CT检查2例,MRI检查1例,手术前确诊16例(69.5%),漏诊2例(8.6%),并发症2例(8.6%),治愈22例(95.6%),死亡1例(4.3%)。结论闭合性十二指肠损伤,多为复合伤,病性复杂,且严重,应仔细检查,早期诊断,早治疗是救治成功的关键。
【关键词】闭合性;十二指肠损伤;诊治;分析
Analysis on 23 Cases of Closed Trauma of Duodenum
ZHAO Ping,LI Yun-fu.The Qiaotou People’s Hospital ofDongguan,Guangdong,Dongguan523523,China
【Abstract】ObjectiveTo explore the diagnosis and treatment of closed trauma of duodenum.MethodsDiagnosis and treatment methods on 13 cases of closed truma of duodenum.ResultsAccording to the abdominal passivity injury,the pain of hypochondrium or back beside renal region was aggravated gradually.20 cases were examined with DPL added with abdomen X ray and B ultrasound.2 cases were done With DPL added with CT.MRI examination was given to 1 case.16 cases were diagnosed before opreation(69.5%),2 cases had missed(8.6%).2 cases occurred to complications(8.6%).22cases were healed(95.6%).1 case died(4.3%).ConclusionThe closed trauma of duodenum,belonged to combined injury.The illness conditions were complex and severe.It should be examined carefully and the early diagnosis and treatment were the key points to get successful cure.
【Key words】
Closed; Trauma of duodenum; Diagnosis and treatment; Analysis
十二指肠损伤多见于2、3部(3/4)以上,识别闭合性十二指肠损伤较困难,这类损伤早期症状多不明显,应提高警惕,手术探查如发现十二指肠周围附近腹膜后有血肿,组织被胆汁染黄或在横结肠系膜根有捻发感音,应高度怀疑十二指肠腹膜后破裂,此时应切开十二指肠外侧后腹膜或横结肠系膜根部后腹膜,以便探查十二指肠降部和横部。现将本院1993~2009年收治的闭合性十二指肠损伤的诊断治疗材料进行分析如下。
1资料与方法
1.1一般资料本组23例中(73.9%),女6例(26.1%),年龄13~68岁,平均32岁。
1.2致伤原因及部位,本组闭合性十二指肠损伤23例中车祸伤12例,重物撞击伤6例,高空坠落伤3例,挤压伤2例,十二指肠壁间血肿或挫伤1例,十二指肠一处裂口11例,2处裂口7例,多处裂口3例,完全断离1例,伤及部位,第1段2例,第2段3例,第3段12例,第4段6例,合并腹直肌断离2例,后腹膜血肿10例,肝破裂6例,肠系膜血肿,脾破裂3例,肝胰腺损伤,肾周血肿2例。
1.3诊断依据根据腹部严重纯性损伤,对上腹部隐痛和压痛,外伤后出现明显的腹胀,腹膜炎,腹腔穿刺,抽出血性或胆汁的消化液体,X光摄片、B超、螺旋CT、MRI检查作出闭合性十二指肠损伤的诊断。
1.4按Fint[1],根据十二指肠损伤的严重程度,把十二指肠损伤分为四类,分类见表1。
表1
十二指肠损伤的分类
分类损伤的程度例数分类比例
Ⅰ十二指肠壁间血肿或挫伤14.3%
Ⅱ穿孔部伤口小于肠管周径30%1669.56%
Ⅲ撕裂伤伤口大于肠管周径的20%但小于70%417.34%
Ⅳ断裂伤伤口大于肠管周径70%28.09%
1.5治疗方法本组23例闭合性十二指肠损伤均行剖腹探查术,十二指肠壁血肿清除术1例,单纯性修补术16例,空肠及胃补片3例,十二指肠空肠ROUX-Yo吻合术2例,十二指肠憩室化1例,术后胃肠减压引流及抗生素、支持,等治疗。
2结果
本组23例治疗中治愈22例,其中2例因十二指肠外瘘,经引流、深静脉高营养支持3~4周后瘘口愈合 ......
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