胰腺外伤的诊断与手术治疗(附28例分析)  

Diagnosis and Surgical Treatment of 28 Cases with Pancreatic Injury

作　　者：王准[1] 朱春富[1] 陈涛[1] 汤黎明[1] 金昆[1] 杨浩华[1] 喻强[1] 朱晟[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院普外科,江苏常州213003

出　　处：《中国临床医学》2009年第3期380-382,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨胰腺外伤的诊断与治疗。方法:回顾分析2000年1月—2008年5月间经手术探查确诊的28例胰腺外伤患者的临床资料。结果:胰腺Ⅰ级损伤5例,Ⅱ级损伤7例,Ⅲ级损伤6例,Ⅳ损伤7例,Ⅴ级损伤3例。行清创或加缝合修补、引流11例,部分胰及脾切除7例,胰空肠roux-en-Y吻合5例,胰管外引流术及2期手术2例,十二指肠憩室化手术2例,Wipple手术1例。治愈24例,死亡4例,病死率14.3%,死因为严重多发伤或失血性休克。发生胰瘘5例,均治愈。2期期手术2例。结论:早期诊断,及时剖腹探查,选择合理术式,有效引流及妥善处理合并伤是治疗胰腺损伤、减少并发症和病死率的关键。Objective： To summarize the clinical diagnosis and surgical treatment of 28 cases of abdominal trauma with pancreatic injury. Methods： A total of 28 cases of abdominal trauma with pancreatic injury from January 2000 to May 2008 was analyzed retrospectively. All patients underwent laparotomy and the early diagnosis, degree of injury, operative management,complications and mortality were studied, respectively. Results： According to the American Association for the Surgery of Trauma（AAST） classification, there were 5 cases of pancreatic injury in grade 1, 7 in grade 2, 6 in grade 3, 7 in grade 4 and 3 in grade 5. The type of surgical procedure for pancreatic injury included debridement, simple drainage or repair of pancreas alone （11 cases）, distal pancreatectomy and splenectomy （7 cases）, external drainage of major pancreatic duct （2 cases）, Whippiers procedure （1 case）, pancreatojejunostomy （5 cases） and duodenal diverticulization （2 cases）. Of the 28 cases, 24 patients were cured and 4 died of severe multiple injuries or hemorrhagic shock. Pancreatic fistula occurred in 5 patients. There were 2 cases receiving delayed surgical reconstruction. Conclusion： Early diagnosis and timely management for pancreatic injury are the keys to the decrease of mortality and the improvement of outcome in patients with blunt abdominal trauma with pancreatic injury.

关 键 词：胰腺外伤 诊断 治疗 

分 类 号：R576[医药卫生—消化系统]