胰腺外伤术后严重并发症的综合治疗  

Comprehensive treatment to severe complications after pancreatic injury （8 cases analysis）

作　　者：朱自满[1] 许月芳[2] 姚咏明[3] 涂玉亮[1] 杜俊东[1] 焦华波[1] 

机构地区：[1]解放军总医院第一附属医院肝胆外科,北京100048 [2]解放军总医院第一附属医院药剂科 [3]解放军总医院第一附属医院全军烧伤研究所

出　　处：《中国急救复苏与灾害医学杂志》2013年第5期403-406,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的总结胰腺外伤术后严重并发症的处理经验。方法2009年3月～2012年12月期间，本科收治8例严重胰腺外伤手术后患者，因术后腹腔感染、出血、消化道瘘等严重并发症而转至我院，对这些病例的临床资料进行回顾性分析。结果8例患者的主要处理方式分别是：急诊行剖腹探查止血＋脾切除＋胰体尾切除术、胃造瘘＋空肠营养管置入术、DSA下肝左动脉＋脾动脉栓塞、经侧腹壁小切口腹膜后脓肿清创引流术、腹腔双套管引流等。全组病例无死亡，均获治愈。1例并发结肠瘘。结论对于复杂胰腺外伤的并发症治疗，首先应对病情准确评估，选择合适的手术干预时机和尽可能采取微创引流方式；保持腹腔引流通畅；高度重视肠内营养，维护机体自身调节功能和免疫力；尽量减少抗菌药物的应用，是治疗成功的保证。Objective To summarize the clinical experiences of severe postoperatic complications after pancreatic injury.Methods A retrospective analysis was performed on 8 cases of severe complications after operation for pancreatic injury in between March 2009 and December 2012. Results The types of the treatment procedures for the 8 patients were involved as follows： 1. laparotomy, splenectomy and resection of pancreatic body and tail; 2. gastrostomy and palcement of jejunum nutrition tube; 3. DSA guided left hepatic artery and splenic artery embolism; 4. bilateral retroperitoneal abscess debridement and drainage; 5. replacement of double-cannula drainage with continuous suction. All of them were cured with one case of colonic fistula healed naturally. Conclusion The key points include accurate assessment of the patient＇s condition, appropriate timing for surgical intervention and minimally invasive surgery, adequate nutrition, maintenance of healthy immunity, unobstructed intraperitoneal drainage, and possibly reducing usage of anti-biotic drugs.

关 键 词：胰腺损伤 并发症 综合治疗 

分 类 号：R657.5[医药卫生—外科学]