Seamon Mark J, Pieri Paola G, Fisher Carol A, Gaughan John, Santora Thomas A, Pathak Abhijit S, Bradley Kevin M, Goldberg Amy J
Department of Surgery, Temple University School of Medicine, PA 19104, USA.
J Trauma. 2007 Apr;62(4):829-33. doi: 10.1097/TA.0b013e318033a790.
We sought to determine whether the performance of pyloric exclusion during repair of penetrating advanced duodenal injuries prevents postoperative duodenal fistulas and improves clinical outcome.
A retrospective chart review of patients from 1995 to 2004 with penetrating duodenal injuries >or=grade II and all combined pancreaticoduodenal injuries was performed. Patients managed either without or with pyloric exclusion were compared on the basis of age, sex, mechanism, injury grade, Injury Severity Score (ISS), hemodynamic stability, the presence of vascular injury or associated injuries, postoperative complications, length of hospital stay, and mortality.
Fifteen of 29 patients were managed without pyloric exclusion and 14 with exclusion. Both groups were similar with respect to age, sex, mechanism, injury grade, ISS, hemodynamic stability, the presence of vascular injury, associated abdominal injuries, and mortality rates. A trend toward a higher overall complication rate (71% vs. 33%), pancreatic fistula rate (40% vs. 0%), and length of hospital stay (24.3 days vs. 13.5 days) was evident in the pyloric exclusion group. No duodenal fistula was detected in either patient group.
In our study population, the performance of pyloric exclusion for penetrating advanced duodenal injury and combined pancreatic and duodenal injuries did not improve clinical outcome. The trend toward a greater overall complication rate, pancreatic fistula rate, and increased length of hospital stay in the pyloric exclusion group suggests that simple repair without pyloric exclusion is both adequate and safe for most penetrating duodenal injuries.
我们试图确定在穿透性晚期十二指肠损伤修复过程中进行幽门旷置术是否能预防术后十二指肠瘘并改善临床结局。
对1995年至2004年患有穿透性十二指肠损伤≥Ⅱ级及所有合并胰十二指肠损伤的患者进行回顾性病历审查。比较未进行幽门旷置术和进行幽门旷置术治疗的患者在年龄、性别、损伤机制、损伤分级、损伤严重程度评分（ISS）、血流动力学稳定性、血管损伤或合并损伤的存在情况、术后并发症、住院时间和死亡率等方面的差异。
29例患者中，15例未进行幽门旷置术治疗，14例进行了幽门旷置术治疗。两组在年龄、性别、损伤机制、损伤分级、ISS、血流动力学稳定性、血管损伤的存在情况、腹部合并损伤及死亡率方面相似。幽门旷置术组总体并发症发生率（71%对33%）、胰瘘发生率（40%对0%）和住院时间（24.3天对13.5天）有升高趋势。两组患者均未检测到十二指肠瘘。
在我们的研究人群中，对穿透性晚期十二指肠损伤及合并胰十二指肠损伤进行幽门旷置术并不能改善临床结局。幽门旷置术组总体并发症发生率、胰瘘发生率升高及住院时间延长的趋势表明，对于大多数穿透性十二指肠损伤，不进行幽门旷置术的单纯修复既充分又安全。
