Ruso Luis, Taruselli Roberto, Metcalfe Matthew, Maddern Guy
Third Department of Surgery, Hospital Maciel, University School of Medicine, Montevideo, Uruguay.
Dig Surg. 2004;21(3):177-80; discussion 781. doi: 10.1159/000079342. Epub 2004 Jun 24.
Access to the 4th part of the duodenum in the region of the ligament of Treitz can be very difficult. Primary repair or traditional duodenal diverticulization is often technically challenging for managing trauma at this location. Due to the frequent concomitant injuries and hemorrhage, a quick, simple and safe repair technique is highly desirable.
3 patients with penetrating injuries to the 4th part of the duodenum were managed by a technique affording good exposure, and involving linear stapling across the bowel proximal and distal to the site of injury, with a jejuno-duodenal anastomosis to the 2nd part of the duodenum, the proximal jejunum having been delivered through a window fashioned in the transverse mesocolon.
All patients survived and suffered no complications of their duodenal repair.
The technique described offers a relatively simple, apparently safe and effective approach to a difficult problem in trauma surgery.
在Treitz韧带区域显露十二指肠第四部可能非常困难。对于该部位的创伤，一期修复或传统的十二指肠憩室化手术在技术上往往具有挑战性。由于常常合并其他损伤和出血，因此非常需要一种快速、简单且安全的修复技术。
3例十二指肠第四部穿透伤患者采用一种能提供良好显露的技术进行治疗，该技术包括在损伤部位近端和远端的肠管上进行线性缝合，将空肠与十二指肠第二部进行吻合，近端空肠通过横结肠系膜上制作的窗口引出。
所有患者均存活，十二指肠修复未出现并发症。
所描述的技术为创伤外科中的一个难题提供了一种相对简单、看似安全且有效的方法。
