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目的:探讨小儿外伤性十二指肠破裂的诊断及治疗。方法:总结本科近年收治的经过手术证实的13例十二指肠破裂患儿,10例采用裂口缝合或断端吻合+减压性空肠造瘘+回输消化液的方法治疗,2例合并胰腺损伤而行改良十二指肠“憩室化”手术,1例胰头断裂且伤及胆总管下段而行胰十二指肠切除术。结果:1例术后死于不可逆休克,1例术后5天出现胰瘘死亡,2例术后分别出现胆瘘及粘连性肠梗阻,均经保守治疗痊愈。结论:减压性空肠造瘘及回输消化液的方法应用于小儿十二指肠损伤的治疗,在预防术后十二指肠瘘起到重要作用,同时消化液的回输,既有利于患儿的术后肠功能早期恢复,又能减少补液量。但合并胰腺损伤者,笔者主张行改良十二指肠“憩室化”术式。
Objective: To investigate the diagnosis and treatment of pediatric traumatic duodenal rupture. Methods: Thirteen children with duodenal rupture confirmed by surgery in recent years were enrolled in this study. Ten patients were treated by split suture or end-to-end anastomosis plus decompressive jejunostomy plus reinfusion of digestive juice. Two patients with pancreaticoduodenal involvement Injury and improved duodenal diverticulum surgery, 1 case of pancreatic head rupture and injury of the common bile duct underwent pancreaticoduodenectomy. Results: One patient died of irreversible shock after surgery and one patient died of pancreatic fistula 5 days after operation. Two patients had biliary fistula and adhesive intestinal obstruction, respectively, and were cured by conservative treatment. Conclusion: The method of decompression jejunostomy and reinfusion of digestive juice in the treatment of pediatric duodenal injury plays an important role in the prevention of postoperative duodenal fistula, meanwhile the return of digestive juice is beneficial Early recovery of intestinal function in children after surgery, but also reduce fluid volume. However, patients with pancreatic injury, the author advocates line improved duodenal diverticulum surgery.