CHẨN ĐOÁN VÀ ĐIỀU TRỊ HẸP DII - DIII TÁ TRÀNG

Abstract

Study aim: We report our retrospective study aim at evaluating  clinical featrure and result of our  surgical traitment of DII-DIII duodenal stricture due to benign lesions. Time: 2019-2022. Result: There were 9 patients including 8 male (88,9%),1female (11,1%),history of alcohol consumption  was 77,9%, previous abdominal  surgery was 37,5%,all patients had gastric outlet obstruction,one patient had biliary obstruction.Gastroduodenal scopy were performed in all patients revealed stricture of the duodenal lumen  due to the intra or extra tumor  of  duodenum. Abdominal CTScaner  detected 3  pancreatic pseudocyst juxta DII duodenum,3 others patients had the compression of gactric cancer to duodenum and the head of pancreas, the two  others patients had tumor of the DII-DIII of duodenum,1 patient had gastric outle and biliary  obstruction   that was consequence of  chronic  pancreatitis and stones in the head of pancreas. Pseudo cyst-duodenostomy (posterior wall of DII duodenum) was performed in 4 pattient, Pseudocyst-Gastrostomy was performed in one patient with the pseudocyst in the head and the body of pancreas,one other patient with pancreatic necrosis was necrosectomy and drained,1 patient with stricture in the junction of the second and the third part of duodunum was duodenectomy  with duodenostomy and anstrectomy, the other patient who had chronic pancreatitis and biliary obstruction was  performed gastrojejunostomy and and biliodigestive anastomosis(Roux en Y).One patient had duodenal stricture due to posterior ulcer of DII duodenum was performed gastro-jejunostomy and had PPI medication. Conclusion: We conclude that stricture of the second and the third part of duodenum due to benign lesions mainly were pseudo cyst of the head of pancreas or the consequence of chronicpancreatitis (88,9%) and posterior ulcer of DII duodenum (Giant ulcer). All had gastric outlet obtruction. The  preoperative diagnoses were tumor in DII-DIII of duodenum or the compresion of pancreatic tumor juxta duodenum. The surgical treatment  were duodenostomy -pseudocyst or the second and third part of duodenum resection or gastro-pseudocystostomy. In case of  duodenal stricture due to ulcer, the operation was gastro- jejunostomy with PPI medication.