Ivatury R R, Nallathambi M, Gaudino J, Rohman M, Stahl W M
Ann Surg. 1985 Aug;202(2):153-8. doi: 10.1097/00000658-198508000-00003.
One hundred consecutive patients with penetrating duodenal injuries were reviewed retrospectively to analyze the results of various methods of treatment. The severity of the abdominal injury was quantified by the Penetrating Abdominal Trauma Index (PATI). The overall mortality was 25%. Sixteen per cent of the deaths were related to extensive associated organ injury, eight per cent to sepsis, and one per cent to concurrent head trauma. Duodenal fistulas occurred in four per cent and were associated with mortality in two per cent. The complications of duodenal fistula, abdominal sepsis, and mortality from sepsis were significantly higher in those patients treated by repair and decompressive enterostomy with or without a serosal patch than in those with repair or resection. The severity of duodenal and associated organ injuries, as well as the clinical status, were similar in both groups. It is concluded that the majority of duodenal injuries from penetrating trauma may be treated effectively by primary repair, and that the use of decompressive enterostomy or serosal patch appears to contribute to an increased morbidity rate.
回顾性分析了100例连续性穿透性十二指肠损伤患者，以分析各种治疗方法的结果。腹部损伤的严重程度通过穿透性腹部创伤指数（PATI）进行量化。总死亡率为25%。16%的死亡与广泛的相关器官损伤有关，8%与脓毒症有关，1%与并发头部创伤有关。十二指肠瘘发生率为4%，其中2%与死亡率相关。与单纯修补或切除相比，采用修补加减压性肠造口术（无论有无浆膜补片）治疗的患者，十二指肠瘘、腹腔脓毒症及脓毒症死亡率等并发症显著更高。两组患者十二指肠及相关器官损伤的严重程度以及临床状况相似。得出结论：大多数穿透性创伤所致的十二指肠损伤可通过一期修补有效治疗，而采用减压性肠造口术或浆膜补片似乎会导致发病率增加。
