摘要：
十二指肠损伤是一种严重的腹腔脏器损伤,十二指肠瘘是胃肠外科最严重的并发症之一,其以病情危重,治疗困难,病死率高而著称.复合性胸腹部闭合性损伤和少部分开放性损伤是十二指肠损伤的常见原因;医源性、创伤性以及合并营养不良、肿瘤、结核及克罗恩病等均是十二指肠瘘的常见原因,目前尚没有理想的诊治手段.十二指肠瘘应针对病因,重在预防,包括围手术期肠外和肠内营养支持治疗,积极纠正低蛋白血症;术中避免游离十二指肠过多而导致残端缺血,残端缝合疏密恰当,保证残端血供;术后避免输入袢梗阻,降低十二指肠残端压力,保证残端无水肿;避免术后残端出血或血肿等.一旦出现十二指肠瘘,在积极禁水、肠内肠外营养、抑酸、抑酶、抗感染治疗及注意维持水电解质酸碱平衡基础上行简单合理的术式,双管法十二指肠减压加腹腔外引流,减少十二指肠瘘相关并发症,以降低病死率,拯救患者生命.%Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis , Crohn' s disease etc . are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
