Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.
Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia.
Colomb Med (Cali). 2021 May 3;52(2):e4104509. doi: 10.25100/cm.v52i2.4509.
The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
严重创伤患者十二指肠损伤的总体发生率为 0.2%至 0.6%，腹部创伤患者的总体患病率为 3%至 5%。这些病例中约有 80%是穿透性创伤引起的，常伴有血管和邻近器官损伤。因此，定义最佳的手术治疗方案仍然存在争议。目前，对于轻度至中度十二指肠损伤，采用一期修复和简单的手术技术进行治疗。然而，对于严重损伤，需要采用复杂的手术技术，但并没有显著改善预后，反而导致死亡率增加。本文旨在通过创建一个实用且有效的算法，详细阐述穿透性十二指肠损伤的手术治疗经验，该算法包括损伤控制手术的基本原则，坚持“少即是多”的理念。对于所有穿透性十二指肠创伤，应尽可能采用一期修复作为手术治疗的首选。当遇到复杂的十二指肠损伤、血流动力学不稳定和/或严重的相关损伤时，应选择损伤控制手术。确定性重建手术应推迟到患者充分复苏和纠正死亡三角后进行。
