Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
Am Surg. 2023 Apr;89(4):1254-1257. doi: 10.1177/0003134821995054. Epub 2021 Feb 17.
Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center.
A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted.
After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy.
Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.
创伤性十二指肠损伤是一种罕见的、潜在破坏性的疾病，其治疗决策极具挑战性。目前缺乏关于十二指肠损伤手术治疗的文献。本研究旨在评估单一创伤中心创伤性十二指肠损伤患者的治疗效果，以确定最佳治疗策略。
对 2013 年至 2020 年在一家一级创伤中心接受治疗的创伤性十二指肠损伤患者进行了回顾性研究。提取患者的人口统计学数据、CT 扫描或术中的损伤分级、手术程序及治疗结果。
排除一名入院时死亡的患者后，23 名患者符合纳入标准。损伤程度为 1 级（n = 7）、2 级（n = 2）、3 级（n = 12）和 5 级（n = 2）；无 4 级损伤。患者主要为男性（83%），中位年龄为 30 岁。19 名患者（82%）接受了手术治疗。9 名 1/2 级损伤患者中有 4 名（44%）有血肿，采用非手术治疗。其余 5 名（56%）1/2 级损伤患者接受了手术治疗，包括一期修复（n = 3）、十二指肠切除（n = 1）和十二指肠周围引流（n = 1）。12 名 3 级损伤患者中，6 例行一期修复，6 例行切除术。行一期修复的 3 名患者和行切除术的 1 名患者发生了十二指肠漏。所有 5 级损伤患者（n = 2）均行胰十二指肠切除术。
1 级和 2 级十二指肠血肿可采用非手术治疗，而裂伤则需要手术修复。3 级损伤患者行切除术的治疗效果可能更好。
