Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Chonnam National University, Gwangju 61469, Korea.
Department of Surgery, Chonnam National University Medical School and Hospital, Chonnam National University, Gwangju 61469, Korea.
Medicina (Kaunas). 2022 Jun 14;58(6):801. doi: 10.3390/medicina58060801.
: Traumatic duodenal injury is a rare disease with limited evidence. We aimed to evaluate the risk factors for postoperative leakage and outcomes of pyloric exclusion after duodenal grade 2 and 3 injury. : We reviewed a prospectively collected trauma database for the period January 2004-December 2020. Patients with grade 2 and 3 traumatic duodenal injury were included. To identify the risk factors for postoperative leakage, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) logistic model. We constructed a receiver operator characteristic (ROC) curve to predict risk factors for postoperative leakage. : During the 17-year period, 179,887 trauma patients were admitted to a regional trauma center in Korea. Of these patients, 74 (0.04%) had duodenal injuries. A total of 49 consecutive patients had grade 2 and 3 traumatic duodenal injuries and underwent laparotomy. The incidence of postoperative leakage was 32.6% (16/49). Overall mortality was 18.4% (9/49). A stepwise multivariable logistic regression and LASSO logistic regression model showed that time from injury to initial operation was the sole statistically significant risk factor. The ROC curve at the optimal threshold of 15.77 h showed the following: area under ROC curve, 0.782; sensitivity, 68.8%; specificity, 87.9%; positive predictive value, 73.3%; and negative predictive value, 85.3%. There was no significant difference in outcomes between primary repair alone and pyloric exclusion. : Time from injury to initial operation may be the sole significant risk factor for postoperative duodenal leakage. Pyloric exclusion may not be able to prevent postoperative leakage.
创伤性十二指肠损伤是一种罕见疾病，相关证据有限。本研究旨在评估 2 级和 3 级外伤性十二指肠损伤患者行毕氏Ⅱ式手术后发生吻合口漏的风险因素和结局。
我们回顾性分析了 2004 年 1 月至 2020 年 12 月期间前瞻性收集的创伤数据库。纳入 2 级和 3 级外伤性十二指肠损伤患者。为了确定术后漏的风险因素，我们使用了逐步多变量逻辑回归模型和最小绝对收缩和选择算子（LASSO）逻辑模型。我们构建了受试者工作特征（ROC）曲线来预测术后漏的风险因素。
在 17 年期间，韩国的一个区域性创伤中心收治了 179887 例创伤患者。其中，74 例（0.04%）患有十二指肠损伤。共有 49 例连续患者患有 2 级和 3 级外伤性十二指肠损伤，并接受了剖腹手术。术后漏的发生率为 32.6%（16/49）。总死亡率为 18.4%（9/49）。逐步多变量逻辑回归和 LASSO 逻辑回归模型显示，从损伤到初次手术的时间是唯一具有统计学意义的风险因素。15.77 小时的最佳阈值的 ROC 曲线显示：ROC 曲线下面积为 0.782；敏感度为 68.8%；特异性为 87.9%；阳性预测值为 73.3%；阴性预测值为 85.3%。单纯行一期修补术和毕氏Ⅱ式手术的患者之间在结局上没有显著差异。
从损伤到初次手术的时间可能是术后十二指肠漏的唯一显著风险因素。毕氏Ⅱ式手术可能无法预防术后漏。
