摘要
目的总结医源性十二指肠损伤的高危因素并对其分级处理进行探讨。方法收集我院1985～2005年收治的医源性十二指肠损伤病例共21例进行回顾性分析,结合有关十二指肠创伤分级的标准有针对性地提出医源性十二指肠损伤的分级及分级处理的方案。结果医源性十二指肠损伤主要来源与胆道疾患相关的手术和腔镜操作。高危因素包括炎症粘连,解剖变异,十二指肠乳头部合并肿块或憩室,医生经验不足或盲于自信及操作技术不当等。根据医源性十二指肠损伤特点和严重程度等多种因素分为5级,大多数采用单纯修补即可,严重损伤者需行转流手术等。结论认识医源性的来源及高危因素,有助于防患未然;医源性十二指肠损伤分级处理对今后医源性十二指肠损伤的合理处理和灵活应用有重要的指导意义和实用价值。
Objective To sum up and discern the high risk factors of iatrogenic duodenl injuries and to evaluate the value of the treatment according to the new trauma scaling ,so as to to facilitate and guide clinical research. Methods 21 patients with iatrogenic duodenal trauma hospitalized and From Jan. 1985 to Oct. 2005, in our hospital were collected and retrospectively reviewed,the duodenum organ iatrogenic injury scale was classified and developed depending on the clinical finding and referring to the injury scale by the American Association for the Surgery of Trauma （A. A. S. T. ） in 1990. Results The iatrogenic duodenal injuries result from various surgery and endoscopic procedures,most from a sequelae to pertinent biliary operation and（or） iatrogenic technical errors of instrnmention. High risk factors responsible for the iatrogenic injuries include inflammatory conglutination, biliary systems anomalies or anatomic variations ,duodenal Vater＇ s papilla with neoplasma or diverticulum, surgeohs with less experience or over self- confidence or some procedures with violence and specific correctable errors,and so on. According to the new grading scheme , the duodenal injuries of the 21 cases were classi- fied as follows ： grade Ⅰ - 5 cases, grade Ⅱ- 6 cases, grade Ⅲ- 5 cases, grade Ⅳ- 3 cases, and grade Ⅴ- 2 cases. Among the patients, 3 cases were treated by drainage. 2 cases underwent simple repair. 8 cases were treated with repair and drainage. 8 cases underwent enterorrhaphy and drainage. Conclusions Knowledge about causal factors of such iatrogenic processes can play a crucial role in their prevention, correct diagnosis, and management. Having the iatrogenic duodenal scaling done well,appears to be an accurate and practical way to select an optimum and flexible treatment and improve the patients＇ s prognosis.
出处
《医学研究杂志》
2007年第7期49-52,共4页
Journal of Medical Research
关键词
医源性
十二指肠损伤
高危因素
分级处理
Iatrogenic
Duodenal injuries
High risk factors
Treatment according to scaling
