胰腺损伤手术后并发症11例临床分析  

Clinical analysis of postoperative complications of 11 patients with pancreatic injury

作　　者：鲁俊[1] 李维勤[1] 童智慧[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院全军普通外科研究所,南京210002

出　　处：《解放军医学杂志》2009年第10期1239-1240,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨胰腺损伤手术后并发症的处理原则和方法。方法回顾性分析2005年1月-2009年5月,南京军区南京总医院全军普通外科研究所收治的11例因胰腺损伤在当地医院行急诊手术后出现并发症的患者的临床资料,所有患者均予禁食、维持水电解质平衡、维护器官功能、早期肠内营养以及抗感染等治疗,部分患者行剖腹引流术,CT引导下穿刺引流和(或)双套管引流。结果11例患者中,临床治愈10例,患者感染症状解除,复查CT感染灶消失。1例死亡,死亡原因为难以控制的腹腔出血及严重腹腔感染。结论胰腺损伤后急诊手术时若引流不彻底,术后易并发感染、胰瘘、假性囊肿等,对这些并发症的处理,应以积极有效的引流为主,配合全身多器官功能的维护和早期肠内营养支持治疗。Objective To explore the principles and methods of treatment of the postoperative complications of pancreatic injury.Method The clinical data of 11 patients with pancreatic injury,admitted from Jan.2005 to May 2009 in Nanjing General Hospital of Nanjing Command,were analyzed retrospectively.Postoperative complications,such as intra-abdominal infections（10 cases）,pancreatic fistulas（3 cases）,duodenal fistula（2 cases）,pancreatic pseudocyst（1 case）,intestinal fistula（1 case） and serious intra-abdominal hemorrhage（1 case）,were found in all the patients after being surgically treated for their pancreatic injury in local hospitals.All the patients received Standard Medical Therapy（SMT）,including fasting,water and electrolyte balance maintenance,organ support,early enteral nutrition supplement,anti-infection agents,etc.In addition,some of patients received other therapies such as aggressive laparotomy,CT-guided percutaneous puncture and/or drainage using double catheterization.Results Of the 11 patients,10 were clinically cured with no infection symptoms or focal infection features,and one died of unmanageable intra-abdominal bleeding and severe abdominal infection.Conclusion After emergency surgical treatment for their pancreatic injury,patients,if with incomplete drainage,are prone to suffering from complications such as abdominal infection,pancreatic fistula and pseudocysts.So,active and effective drainage should be the most important treatment for such complications,with combination of organ support and early enteral nutrition supplementation.

关 键 词：胰腺损伤 腹腔感染 手术后并发症 

分 类 号：R657.5[医药卫生—外科学]