Roux-en-Y吻合术在胰或十二指肠损伤中应用体会.docVIP

Roux-en-Y吻合术在胰或十二指肠损伤中应用体会 　【关键词】 Roux-en-Y吻合术；胰或十二指肠损伤；应用体会 【摘要】 目的 探讨Roux-en-Y吻合术在胰或十二指肠损伤中的运用。方法 我院1995~2004年共收治胰、十二指肠损伤患者14例，其中应用Roux-en-Y吻合术处理的共8例，胰腺损伤3例，按OIS分度标准分类：Ⅱ级1例，Ⅲ级2例，十二指肠损伤5例，损伤口均大于肠周壁的1/2。结果 本组8例中7例治愈，1例死亡，死于十二指肠及结肠瘘、腹腔感染及多器官功能衰竭。结论 对于Ⅱ级胰腺损伤中虽无主胰管损伤，但组织丢失较严重的挫裂伤及Ⅲ级胰腺损伤及十二指肠损伤损伤口大于肠周壁1/2的患者均采用Roux-en-Y吻合术式处理取得满意疗效。合理的术式选择，对治疗效果有较大影响，除术式的选择外，术中彻底清创、损伤肠管肠腔内彻底减压、细丝线缝合、术中及术后充分彻底的引流及术后常规应用抑制胰腺分泌的药物，是保证胰或十二指肠损伤顺利恢复的关键。 　　【关键词】 Roux-en-Y吻合术；胰或十二指肠损伤；应用体会 　　Experience of applying Roux-en-Y anastomosis in pancreatic or duodenal injuries :a report of 8 cases 　　【Abstract】 Objective The purpose of this study was to discuss the application of Roux-en-Y anastomosis for pancreatic or duodenal injuries.Methods Our hospital has treated 14 patients with pancreas or duodenum harm from 1995 to 2004,of which 8 patients were treated by Roux-en-Y anastomosis.3 patients had pancreatic wounds（1 patient was Ⅱ grade and 2 patients was Ⅲ grade according to OIS standard）and 5 patients had duodenal harm which were wall bigger than half the intestines wall.Results 7 patients were healed,and 1 patient died of fistulae of duodenum and colon,abdominal infection,and multiple organs failure.Conclusion Roux-en-Y anastomosis gained satisfactory effects for Ⅱ grade pancreatic injuries which had no main pancreatic harm,but tissues lost seriously,and Ⅲ grade pancreatic injuries,duodenal injuries which were bigger than half of the intestines wall.Reasonable surgical methods influenced the curative effect largely.Except surgical method,cleaning wound thorough in the period of operation,complete decompression intestinal cavity,suturing using small needles and thread,full drainage in and after operation,and using medicine to refrain pancreas secretion after operation all are the keys to ensure pancreatic or duodenal injuries recovered smoothly. 　　【Key words】 Roux-en-Y anastomosis;pancreas or duodenum harm;experience of application 胰腺固定于后腹膜，受伤的机会不多，因此胰腺外伤比较少见，既往约占腹部外伤的1%~2%，近年来，由于交通事故增多，胰腺外伤