Degiannis E, Krawczykowski D, Velmahos G C, Levy R D, Souter I, Saadia R
Department of Surgery (Baragwanath Hospital), University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa.
World J Surg. 1993 Nov-Dec;17(6):751-4. doi: 10.1007/BF01659085.
This study comprises 74 patients with penetrating injuries of the duodenum. Sixty-three of these had sustained gunshot wounds, many of which were high velocity. The change in the incidence and the severity of the gunshot injuries within the last few years resulted in changes in the operative management of the duodenal wound with gradually improving results. When pyloric exclusion was added to the operative management of grade III duodenal injuries, the postoperative leakage rate was 12%. When only primary repair was done, the leakage rate was 43%. We suggest that pyloric exclusion be added to the treatment of most severe grade II and all grade III gunshot duodenal injuries. The adequacy of primary repair and pyloric exclusion in grade IV injuries requires further study.
本研究包括74例十二指肠穿透伤患者。其中63例为枪伤，许多是高速枪伤。过去几年枪伤发生率和严重程度的变化导致十二指肠伤口手术处理方式的改变，结果也在逐步改善。当在Ⅲ级十二指肠损伤的手术处理中增加幽门旷置术时，术后渗漏率为12%。仅进行一期修复时，渗漏率为43%。我们建议在大多数严重的Ⅱ级和所有Ⅲ级枪伤性十二指肠损伤的治疗中增加幽门旷置术。Ⅳ级损伤中一期修复和幽门旷置术的充分性需要进一步研究。
