钝性胰腺损伤合并主胰管损伤的诊断和治疗：附35例报告  

Diagnosis and treatment of blunt pancreatic injury and main pancreatic duct injury： a report of 35 cases

作　　者：陈庆永[1] 王春友[2] 蒋春舫[1] 王琳芳[1] 方开锋[1] 陈阳龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院急诊外科,武汉市430022 [2]华中科技大学同济医学院附属协和医院胰腺外科中心,武汉市430022

出　　处：《中华肝胆外科杂志》2007年第3期168-170,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨钝性胰腺损伤合并主胰管损伤的早期诊断和合理的外科治疗方法。方法回顾性分析1995年4月至2005年4月间35例胰腺钝性伤病人的临床资料，其早期诊断和损伤严重度的分级根据术前动态的淀粉酶及影像学检查（特别是动态螺旋CT和MRCP扫描）和早期外科手术的术中发现，就胰腺钝性伤的早期诊断方法、不同的手术处理方式及并发症等进行分析。结果22例Ⅲ级胰腺损伤病人中，14例行远端胰腺切除术和脾切除术，6例行远端胰腺切除术和保留脾脏手术，2例行单纯胰周引流术。8例Ⅳ级胰腺损伤病人中，2例行远端胰腺切除术和脾切除术，2例行胰尾切除术，4例行胰腺空肠Roux-en-Y吻合术。5例Ⅴ级胰腺损伤病人中，4例由于复合伤情较重且合并十二指肠损伤，根据伤害严重度（injury severity score，ISS）评分，首先应用损伤控制手术先进行止血和制止肠内容物的外溢、胰腺外引流等简化手术，于急诊ICU监护待血液动力学稳定后，于受伤后48-72h再次行彻底性手术，1例胰头严重毁损伤行Whipple手术，平均住院时间是40d（2～147d），总死亡率是14．3％（35例中5例），其余均治愈。结论对胰腺损伤病人，及时正确的诊断和合理的外科手术治疗是减少死亡率，改善预后的重要因素。Objective To explore the methods for early diagnosis and surgical treatment of blunt pancreatic injury and main pancreatic duct injury. Methods The clinical data of 35 patients with pancreatic injuries treated in our hospital from April 1995 to April 2005 were retrospectively analyzed. The early diagnosis and assessment of injury severity were based on repeated amylase determination and imaging studies （especially repeated CT scanning and MRCP） and proved by surgical findings. Resuits Of the 22 patients of grade Ⅲ, 14 underwent distal pancreatectomy in combination with splenectomy, 6 pancreatectomy with splenic preservation and 2 drainage. Amongst the 8 patients of grade , 2 received distal pancreatectomy in combination with splenectomy, 2 distal pancreatectomy and 4 Roux-en-Y pancreaticojejunostomy. Of the 5 patients of grade Ⅴ, 1 underwent the Whipple＇s procedure and 4 were employed to serve as the damage control. The priority in the primary operative approach was damage control. It consisted of bleeding control, enteral spillage control, pancreatic damage assessment, especially recognition of any ductal injury and generous drainage of the injured pancreas. Definitive treatment in the severely injured patients had to be performed after hemodynamic stabilization in emergency ICU by an experienced pancreatic surgeon. The mean duration of hospitalization was 40 d （2-147 d）. The overall mortality was 14.3% （5 of the 35 patients）. Conclusions Correct and timely diagnosis and surgical treatment are important for decreasing mortality in patients with pancreatic trauma.

关 键 词：胰腺损伤 诊断 损伤控制 治疗 

分 类 号：R686[医药卫生—骨科学]