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| 題 名 | 延遲診斷之十二指腸鈍傷病患的外科治療與結果 |
|---|---|
| 作 者 | 方禎鋒; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 26:1 民82.01-02 |
| 頁 次 | 頁1545-1550 |
| 分類號 | 416.243 |
| 關鍵詞 | 延遲診斷; 十二指腸鈍傷; 外科治療; Duodenal trauma; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 從1981年1月至1990年12月,台北長度紀念醫院共治療10例延遲診斷超過24小時的十二指腸鈍傷病患。這10例病忠診斷延遲的時間最短為25小時,最長為7天。造成診斷延遲的原因,有4例是在第一次手術時未發現十二指腸破裂;有3例是病患延遲超過24小時才就醫;有2例是受傷後先在地方醫院接受保守療法後再轉送;有1例在本院觀察30小時以後才作出診斷。這10例病患經過手術治療才是有1例死亡,死亡率為10%。有4例發生與十二指腸外傷有關的併發症。所施行的手術,有6例是接受直接清創縫合及幽門封閉術(pyloric exclusion);有2例是接受十二指腸及胰臟頭切除手術(pancreaticoduodenectomy);有1例是接受直接清創縫合、網膜補強(omental patch closure)及逆行性空腸造瘻術;另有1例接受直接清創縫合、胃造瘻、空腸造瘻及膽囊造瘻術。接受直接清創縫合及幽門封閉術的6例病患,結果相當良好;6例全部存活,且只發生1個併發症。10例病忠中有8例需要營養支持,其中有4例在手術中即已作了空腸造瘻。這4例病患經由空腸造瘻灌食效果良好。十二指腸鈍傷是個相當少見而又困難診斷的傷害。其預後受診斷時間的早晚、手術式的選擇及合併傷害的嚴重度等因素所影響。早期診斷可減少併發症,並且降低醫療成本。剖腹採查時將整段十二指腸完全游離出來檢查,是避免手術中診斷遺漏的唯一方法。對延遲診斷的病例,幽門封閉術及空腸造瘻灌食術應有助於預後的改善。 |
| 英文摘要 | Between January 1981 and December 1990, 37 patients with blunt doudenal injury were treated at Chang Gung Memorial Hospital. Ten of the 37 received their operations more than 24 hours after injury. For these ten patients, there were four duodenal-related complications and one death; the mortality rate was 10% and morbidity rate 40%. Causes of the delay, the operative procedures, and factors influencing outcome are reviewed. Blunt duodenal rupture, an uncommon and obscure in-jury, must be suspected in every patient with blunt abdominal trauma. One should pay scrupulous attention intraoperatively, to searching for duodenal rupture. Complete mobilization of the surrounding structures to provide exposure of the entire duodenum is necessary. Pyloric exclusion and a feeding jejunostomy might be helpful for treatment of patients with duodenal trauma undergoing delayed surgical care. |
本系統中英文摘要資訊取自各篇刊載內容。