Nassoura Z E, Ivatury R R, Simon R J, Kihtir T, Stahl W M
Department of Surgery, New York Medical College, Bronx.
Am Surg. 1994 Jan;60(1):35-9.
Based on a retrospective analysis of 100 penetrating duodenal injuries, the role of primary repair or resection and anastomosis was assessed prospectively in 66 patients (1986-1992). Duodenal exclusion was reserved for extensive combined pancreato-duodenal injuries. Seven of the 66 patients died from extensive abdominal trauma (mean Abdominal Trauma Index, ATI 70) within 48 hours of admission. Fifty-six patients had primary repair, while pyloric exclusion was performed for three patients with extensive pancreatico-duodenal injuries. Three patients (5.1%) developed duodenal fistula, two being in the primary repair group (3.6%). All three patients had associated injury to the head of the pancreas. Four of the 59 patients died, one attributed to the duodenal repair, for a duodenal mortality of 1.7 per cent. Of the anatomic (ATI, duodenal, vascular, and pancreatic injury scores) and physiologic variables (shock, transfusions) analyzed, the ATI, the Duodenal Injury Score, and the Colon Injury Score were significantly higher in the fistula group. We conclude that the vast majority of penetrating duodenal injuries should be managed by primary repair or resection and anastomosis. Complex duodenal decompression or diverticulization rarely are necessary. Complex procedures should be considered for patients with ATI > 40, Duodenal Injury Score > 12, and the presence of injury to the head of the pancreas.
基于对100例十二指肠穿透伤的回顾性分析，对66例患者（1986 - 1992年）前瞻性评估了一期修复或切除吻合术的作用。十二指肠旷置术仅用于广泛的胰十二指肠联合损伤。66例患者中有7例在入院后48小时内因严重腹部创伤（平均腹部创伤指数，ATI 70）死亡。56例患者接受了一期修复，3例广泛胰十二指肠损伤患者行幽门旷置术。3例患者（5.1%）发生十二指肠瘘，其中2例在一期修复组（3.6%）。所有3例患者均合并胰头损伤。59例患者中有4例死亡，1例归因于十二指肠修复，十二指肠死亡率为1.7%。在所分析的解剖学（ATI、十二指肠、血管和胰腺损伤评分）和生理学变量（休克、输血）中，瘘管组的ATI、十二指肠损伤评分和结肠损伤评分显著更高。我们得出结论，绝大多数十二指肠穿透伤应通过一期修复或切除吻合术进行处理。很少需要复杂的十二指肠减压或憩室化手术。对于ATI > 40、十二指肠损伤评分> 12且存在胰头损伤的患者，应考虑采用复杂手术。
