【摘要】 目的吸取十二指肠损伤延迟诊治的教训,以期改进。方法将确诊>1 d定为延迟诊断。小结外伤性损伤(DTI)7例和医源性损伤(DII)3例的诊治。闭合性DTI 6例伤后>1 d至2个月确诊;开放性DTI伴腹内多发伤1例,再手术确诊;DII 3例原手术中遗漏。该10例分别行裂伤修补、空肠造瘘、胃造瘘及逆顺向空肠造瘘(“三管法”)、腹膜后或腹腔引流;其中2例再行胃空肠吻合、髂凹引流。结果6例术后并发症为十二指肠瘘、腹腔或腹膜后感染及ARDS;治愈7例,3例死于术后并发症。结论医生认识不足和伤员延迟就诊使诊断延误。密切观察病情变化、腹(腰)部穿刺和影像学方法协助早诊。必要时及早手术探查,探查应系统。十二指肠相邻器官手术,应警惕DII的可能。延迟者手术难度和并发症增加、甚至死亡。单纯修补应禁忌,三管法可能有效。更多还原

【Abstract】 Objective To draw lessons from delayed diagnosis and treatment of duodenal injury to improve its management. Methods The accurate diagnosis made over 1 d after the injury was defined as delayed diagnosis. The diagnosis and treatment were summed up in 7 cases of traumatic injury (DTI) and 3 of iatrogenic injury (DII). Six cases of closed DTI were diagnosed 1 d to even 2 months after the injury and the 1 of open DTI in combination with abdominal multiple injuries was diagnosed in the reoperation. The 3 cases of DII were overlooked in the initial operation. The operative procedures included simple repair, jejunostomy, gastrostomy and retrograde and antegrade jejunostomies and drainage of retroperitoneal space and abdominal cavity. In 2 cases, reoperations of gastrojejunostomy and drainage of iliac fossa were performed. Results Postoperative complications including duodenal fistula, peritoneal or retroperitoneal infection and ARDS occurred in 6 patients. Of all the 10 patients, 7 recovered and 3 died from postoperative complications. Conclusions The reasons for delayed diagnosis of duodenal injury are that doctors do not pay close attention to it and the patients go to get medical consultation late. Closely observing the changes in symptoms and signs, performing abdominal or lumbar paracentesis and using some imaging methods are helpful for accurate diagnosis of the duodenal injury.更多还原