Abstract: Objective:To investigate the application value of doubletube gastrostomy in the duodenal rupture repair.
Methods:The retrospective cohort study was adopted. The clinical data of 41 patients who underwent duodenal rupture repair at the Chongqing Emergency Medical Center from January 2005 to January 2015 were collected. Twentyfive patients using Hassan tripletube gastrostomy technique between January 2005 and December 2009 were divided into the tripletube (TT) group and 16 patients using doubletube gastrostomy technique between January 2010 and January 2015 were divided into the doubletube (DT) group. Duodenal rupture repair included suture repair, pedicled ileal flap to repair duodenal defect and end to end anastomosis. Patients underwent the regular treatments of antiinfection, antishock, somatostatin inhibition, nutritional support and complications prevention. Patients were injected with 500 mL/d nutrient solution using enteral nutritional tube from 48 hours after operation, and then dosage was gradually increased to total enteral nutrition and digestive juices collected from drainage fluid were transfused to enteral nutritional tube. The postoperative complications (duodenal fistula, intraperitoneal infection, incision infection, pulmonary infection and intestinal obstruction), operation method, operation time, volume of blood loss, enteral nutritional tube removal time and duration of hospital stay were observed. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using an independent sample t test. Comparison of count data was analyzed using chisquare test or Fisher exact probability.Results:All the 41 patients underwent duodenal rupture repair, including 28 using suture repair of duodenal rupture, 8 using pedicled ileal flap to repair duodenal defect and 5 using end to end anastomosis, with the intraoperative duodenal decompression and placement of intestinal feeding tube. The operation time was (184±38)minutes in the TT group and (153±37)minutes in the DT group, with a significant difference between the 2 groups (t=2.566, P<0.05). The volume of intraoperative blood loss was (1 112±707)mL in the TT group and (1 011±595)mL in the DT group, with no significant difference between the 2 groups (t=0.476, P>0.05). The proportions of duodenal fistula, intraperitoneal infection, incision infection and pulmonary infection in the TT and DT groups were 3/25 and 1/16, 8/25 and 5/16, 9/25 and 4/16, 10/25 and 6/16, respectively, showing no significant difference between the 2 groups (χ²=0.003, 0.545, 0.026, P>0.05). Eleven patients were complicated with postoperative early intestinal obstruction, including 10 (3 with partial duodenal stenosis and 7 with incomplete small intestinal obstruction) in the TT group and 1 (partial duodenal stenosis) in the DT group, showing a significant difference in the incidence of postoperative early intestinal obstruction between the 2 groups (P<0.05). Patients with early intestinal obstruction had remission after conservative treatment of gastrointestinal decompression and fasting. The time of intestinal feeding tube indwelling and duration of hospital stay were  (25±9)days and (29±9)days in the TT group, (19±9)days and (23±8)days in the DT group, with significant differences between the 2 groups (t= 2.188, 2.120, P<0.05).
Conclusion:Doubletube gastrostomy technique for duodenal rupture repair can simplify the operation procedures and reduce operation time, recovery time and risk of postoperative intestinal obstruction, with a reliable efficacy.