闭合性胰腺损伤的诊断与治疗  

The diagnosis and treatment of blunt pancreatic injury

作　　者：黄东航[1,2] 张爱龙[1,2] 李华水[1,2] 邱丽贞[1,2] 王瑞娟[1,2] 陈新[1,2] 林强[1,2] 游振辉[1,2] 

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院基本外科,福州350001

出　　处：《创伤与急诊电子杂志》2013年第3期15-18,共4页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨闭合性胰腺损伤的诊断和治疗方法。方法回顾性分析1991~2013年福建省立医院收治的32例胰腺闭合性损伤的临床资料。结果术前诊断胰腺损伤13例(41%),其余19例(59%)均经术中探查确诊。非手术治疗2例,手术治疗30例:胰腺清创引流19例,远端胰腺切除6例(其中同时切除脾脏4例),近端胰腺缝闭、远端胰腺空肠Roux-Y吻合术4例,胰十二指肠切除1例。治愈27例(84%),死亡5例(16%)。结论多数胰腺闭合性损伤须经剖腹探查确诊。避免漏诊的关键是在腹部外伤的诊疗特别是在剖腹探查术中高度警惕胰腺损伤。闭合性胰腺损伤治疗以手术为主。手术方式根据胰腺损伤的分级、合并伤及全身情况合理选择。Objective To explore the diagnosis and treatment strategy of blunt pancreatic injury. Method The data of 32 cases of blunt pancreatic injury admitted to Fujian Provincial Hospital from 1991 to 2013 were analyzed retrospectively. Result 13 cases(41%) were diagnosed preoperatively, and the other 19 cases(59%) were diagnosed during the laparotomy. 2 cases underwent non-surgical treatment. 30 cases underwent surgical treatment, among whom 19 cases underwent pancreatic debridement and drainage; 6 cases underwent distal pancreatectomy(4 cases undergoing distal pancreatectomy plus splenectomy were included); 4 cases underwent distal Roux-Y pancreajejunostomy plus proximal pancreas closure, and 1 case underwent pancreatoduodenectomy. 27 cases(84%) were cured, and 5 cases died(16%). Conclusion Most cases of blunt pancreatic injury are diagnosed through laparotomy. The key to avoid missed diagnosis is to maintain vigilance for pancreatic injury in diagnosis and treatment of abdominal trauma, especially in laparotomy. Surgical operation is the main approach to treat blunt pancreatic injury. Surgical procedure should be selected based on the grading scale of pancreatic injury, associated injuries and overall conditions of the patient.

关 键 词：胰腺 损伤 诊断 外科手术 

分 类 号：R657.5[医药卫生—外科学]