目的总结十二指肠损伤的诊断和治疗经验。方法对我院1989年1月至2003年7月期间收治的13例十二指肠损伤患者的临床资料进行回顾性分析。本组均经手术治疗，行十二指肠单纯修补术6例，十二指肠憩室化手术1例，改良憩室化术4例（3例缝扎十二指肠），Roux-en-Y吻合术1例，T管引流及脓肿切开引流术1例。结果治愈11例； 死亡2例, 其中1例死于十二指肠瘘，另1例死于肝功能不全。结论十二指肠损伤的早期诊断和手术处理非常重要； 缝扎十二指肠的改良憩室化手术是治疗重症十二指肠损伤的一种较理想术式。
Objective To study the clinical features of duodenal trauma and its surgery to improve the level of diagnosis and treatment. Methods Methods of diagnosis and results of surgical treatment were analysed retrospectively of 35 cases of duodenal trauma. Results The positive rates of abdominal X-ray and abdominal puncture were 32.0%, 13.3% respectively. The extraperitoneal duodenal injuries occured in 30(85.7%) cases. 25(71.4%) cases were complicated by additional intraabdominal organ injuries. The rate of failure to diagnose intraoperatively was 11.4%. The postoperative complication rate was 37.1% and the death rate was 11.4%. Conclusion Duodenal trauma is characteristic of low diagnostic rate preoperatively, high failure rate intraoperatively and most of the cases are complicated by other intraabdominal organ injuries, so both the complication and mortality are high. If the diagnosis is certain, surgery should been taken suitably. This is the key to improve prognosis. The procedure performed is based on the condition of duodenal injuries.
目的 探讨胆道镜在探查十二指肠损伤中的临床价值。方法 回顾性分析我院2001年3月至2011年2月期间收治的28例十二指肠损伤患者应用胆道镜探查的临床资料。结果 开腹后直视十二指肠球部损伤7例，胆道镜探查发现其中3例合并水平部损伤，2例合并降部与水平部交界处损伤。直视下未见十二指肠损伤患者中胆道镜探查发现十二指肠损伤21例，其中降部5例，水平部6例，降部与水平部交界处3例，升部2例，十二指肠多处伤5例。按Lucas分级，Ⅰ级4例，Ⅱ级12例，Ⅲ级7例，Ⅳ级5例。Ⅰ级损伤患者中3例在胆道镜下未见血肿继续增大，局部损伤未行处理；1例血肿压迫十二指肠导致肠腔狭窄，在胆道镜引导下避开肠系膜血管，切开肠系膜行血肿清除及止血术。Ⅱ级损伤患者中6例在胆道镜引导下避开肠系膜血管切开肠系膜行全层缝合。其他病例分别采用十二指肠破口空肠Roux-en-Y吻合术（Ⅱ级3例，Ⅲ级1例）、十二指肠空肠端端吻合术（Ⅱ级1例，Ⅲ级3例）、十二指肠空肠Roux-en-Y吻合术（Ⅱ级2例，Ⅲ级2例，Ⅳ级1例）、Graham简化术（Ⅲ级1例，Ⅳ级4例），术后通过空肠切口处放置十二指肠内引流。术后发生并发症12例，其中肠瘘2例，胰瘘2例，肠梗阻3例，腹腔脓肿2例，胰腺脓肿3例。死亡3例，治愈25例。结论 在十二指肠损伤患者中应用胆道镜探查，可以确切诊断十二指肠受损情况，防止漏诊，也可以在胆道镜引导下行相应部位的处理。
目的 探讨十二指肠损伤后预防肠瘘的合理手术方式。方法 对我院2005年3月至2009年10月期间收治的28例十二指肠损伤患者的临床资料进行回顾性分析。结果 28例均行手术治疗，其中1例因多器官功能衰竭于术后第2天死亡，3例十二指肠瘘均经保守治疗后痊愈。27例患者术后随访2～6个月（平均3.5个月），2例发生不全性肠梗阻，1例发生盆腔脓肿，均经非手术治疗后痊愈。结论十二指肠损伤后选择合理的手术方式是预防术后发生十二指肠瘘的关键因素。
目的 探讨十二指肠损伤的诊断、手术治疗及手术方式的选择。方法 对我院2000年3月至2007年5月收治的16例十二指肠损伤患者的临床资料进行回顾性分析。结果 16例均进行手术治疗，仅3例术前明确诊断，术中确诊13例； 术后并发症4例； 16例均治愈出院。结论 十二指肠损伤的病情复杂，治疗成败的关键是掌握好早期手术探查指征和选择合适的术式。对于较重的Ⅲ、Ⅳ级十二指肠损伤者，改良十二指肠憩室化手术为一种较理想的手术方法。
Objective To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma. Methods Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected. The injury causes, diagnostic methods, surgical treatment methods, curative effect, and complications of patients were analyzed. Results A total of 8 patients were included. Among them, there were 7 males and 1 female. The age ranged from 17 to 66 years old, with an average of (44.4±19.3) years old. There were 5 cases of traffic accident injury, 2 cases of crush injury, and 1 case of falling injury. There was 1 case of duodenal bulb injury, 3 cases of descending part injury, 3 cases of horizontal part injury and 1 case of both descending and horizontal injuries. According to the scale of American Association for the Surgery of Trauma for duodenal trauma, there were 5 cases of grade Ⅱ injury, 2 cases of grade Ⅲ injury, and 1 case of grade Ⅳ injury. All patients underwent CT scan, of which 2 cases were directly diagnosed with duodenal injuries by CT, and the remaining cases diagnosed by intraoperative exploration. All patients underwent surgical treatment, including 4 cases of pancreaticoduodenectomy, 2 cases of duodenal repair and gastrojejunostomy, 1 case of duodenal repair plus jejunostomy, and 1 case of superior mesenteric vein repair, pancreatic necrotic tissue removal, and abdominal catheterization for smooth drainage. One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery, 1 died of multiple organ failure during the resuscitation phase after damage control surgery, 3 developed intra-abdominal infection and cured by anti-infective treatment. Conclusions Early clinical manifestations of traumatic duodenal injuries are atypical, and imaging findings might not be clear. For trauma patients suspected of having duodenal injury, rigorous vital sign monitoring is necessary. Once vital signs stabilize, exploratory surgery should be actively considered to identify the location of the injury and perform appropriate surgical procedures. Adequate postoperative enteric decompression and drainage should be ensured.