损伤控制外科在闭合性胰腺创伤中的应用  

Damage control surgery for pancreatic injuries after blunt abdominal trauma

作　　者：赵振国[1,2] 李幼生[1,2] 王剑[1,2] 李刚[1,2] 王凯[1,2] 胥子玮[1,2] 郑磊[1,2] 李宁[1,2] 黎介寿[1,2] 

机构地区：[1]南京大学医学院临床学院,210002 [2]南京军区南京总医院解放军普通外科研究所,210002 南京军区南京总医院解放军普通外科研究所,210002

出　　处：《中华外科杂志》2012年第4期299-301,共3页Chinese Journal of Surgery

基　　金：全军十一五医药卫生专项基金资助项目（062017）

摘　　要：目的总结闭合性胰腺创伤的外科治疗经验。方法回顾性分析2001年1月至2010年12月收治的42例闭合性胰腺创伤患者的临床资料。其中男性38例，女性4例；年龄13-65岁，平均年龄31岁。根据美国创伤外科协会脏器损伤委员会（AAST）的器官损伤分级：Ⅰ级3例，Ⅱ级12例，Ⅲ级9例，Ⅳ级13例，Ⅴ级5例。创伤严重程度评分：（27±21）分。AAST分级Ⅱ级及以上患者均采取损伤控制的胰周外引流加三造口（胃造口、空肠造口、胆囊造口）术。结果术前cT诊断阳性率79．9％（30／38）；手术治疗40例，非手术治疗2例。损伤控制外科理念指导下的单纯腹腔引流术及三造口术32例，胰腺修补或胰尾切除术6例，胰十二指肠切除或胰尾空肠吻合术2例。治愈40例（95．2％），死亡2例（4．8％），共有16例（38．1％）出现胰漏、肺部感染等并发症。结论腹部CT检查有助于闭合性胰腺创伤患者的术前诊断；以损伤控制外科理念处理闭合性胰腺创伤有可能提高患者生存率，但术后并发症的发生率仍很高，需要进一步完善现有的外科治疗措施。Objective To summarize the management of pancreatic injuries after blunt abdominal trauma. Methods The clinical data of 42 patients with blunt pancreatic injury admitted from January 2001 to December 2010 was analyzed retrospectively. There were 38 male and 4 female patients, aging from 13 to 65 years with a mean of 31 years. The organ injury scaling of Committee of the American Association for the Surgery of Trauma （AAST grade）： grade Ⅰ in 3 patients, grade Ⅱ in 12 patients, grade Ⅲ in 9 patients, grade Ⅳ in 13 patients and grade Ⅴ in 5 patients. The mean injury severity score was 27±21. Patients above AAST grade Ⅱ underwent peritoneal drainage and ＂three neostomy＂ （ gastrostomy, jcjunostomy and gallbladder） according to damage control theory. Results Thirty-eight patients got abdominal CT scanning with a positive rate of 79. 9% （30/38）. Forty patients underwent surgical procedures, and 2 patients with non-operative management. The surgical procedures include peritoneal drainage and ＂three neostomy＂ in 32 patients, pancreas suture or pancreatic tail resection in 6 patients, pancreatoduodenectomy or caudal panereaticojejunostomy in 2 patients. Forty patients （95.2%） survived, 2 patients （4. 8% ） died and 16 patients （38. 1% ） had complications such as pancreatic fistula, pulmonary infection. Conclusions Abdominal CT scanning will benefit the preoperative diagnosis of blunt pancreatic trauma. Although the survival rate of patients with blunt pancreatic trauma might be improved by using the damage control surgery, the management of damage control surgery also needs to be modified because of the high rate of complications.

关 键 词：腹部损伤 创伤 非贯通性 胰腺 外科手术 

分 类 号：R657.5[医药卫生—外科学]