Objective To study the clinical features of duodenal trauma and its surgery to improve the level of diagnosis and treatment. Methods Methods of diagnosis and results of surgical treatment were analysed retrospectively of 35 cases of duodenal trauma. Results The positive rates of abdominal X-ray and abdominal puncture were 32.0%, 13.3% respectively. The extraperitoneal duodenal injuries occured in 30(85.7%) cases. 25(71.4%) cases were complicated by additional intraabdominal organ injuries. The rate of failure to diagnose intraoperatively was 11.4%. The postoperative complication rate was 37.1% and the death rate was 11.4%. Conclusion Duodenal trauma is characteristic of low diagnostic rate preoperatively, high failure rate intraoperatively and most of the cases are complicated by other intraabdominal organ injuries, so both the complication and mortality are high. If the diagnosis is certain, surgery should been taken suitably. This is the key to improve prognosis. The procedure performed is based on the condition of duodenal injuries.
Objective To modify the method for aortic end strengthening in acute type A aortic dissection operation, and investigate its clinical efficacy. Methods We modified the method for aortic end strengthening in acute aortic dissection operation based on ‘Sandwich method’ in the department of thoracic and cardiovascular surgery of West China Hospital. From January 2006 to December 2008, twentyeight patients with acute type A aortic dissection underwent modified aortic end strengthening operation. We made adventitia turn over and enfold to strengthen the aortic end in 10 cases, and placed stripshaped felt or pericardium belts between dissection (between adventitia and intima)and inner intima and strengthened the aortic end by suture in 18 cases. The hemorrhage of anastomotic stoma and the postoperative early prognosis were observed. Results No bleeding complication was found in all the cases. Two cases died, one died of severe low cardiac output syndrome and another died of multiple organ failure. No nervous system complication was found except that 2 cases had delayed revival. No sternum and surgical incision related complication was found. The rest 26 cases were cured and discharged. Conclusion The modified method for aortic end strengthening can not only strengthen the aortic end but also make people be able to find the petechia of anastomotic stoma clearly, then stitch hemostasia could be done effectively. The method is easy to implement and effective, it should be extend in clinic.
