腹腔内负压封闭引流治疗严重胰腺十二指肠损伤:附16例报告  

Use of vacuum sealing drainage in treatment of severe pancreaticduodenal injuries:a report 16 cases

作　　者：霍景山[1] 陈积圣[2] 陈务民[1] 庄志浩[1] 吴日钊[1] 

机构地区：[1]广东省佛山市中医院外一科,广东佛山528000 [2]中山大学附属孙逸仙纪念医院肝胆胰外科,广东广州510120

出　　处：《中国普通外科杂志》2014年第3期343-347,共5页China Journal of General Surgery

摘　　要：目的：探讨应用负压封闭引流（VSD）技术治疗严重胰腺十二指肠损伤的价值。方法：回顾性分析腹腔内应用VSD技术引流治疗的16例严重胰腺十二指肠损伤患者的临床资料；患者AAST损伤分级分别为Ⅲ级10例，Ⅳ级4例，V级2例。结果：患者的胰腺裂伤仅进行清创和创面止血、十二指肠裂口行单层缝合、合并伤予以相应处理、均在胰腺横断处和十二指肠损伤处行VSD；手术时间65—235min，平均126min；术后无1例病死，1例患者因术后腹腔出血转外院治疗，余15例腹部外伤住院时间为16-45d；Ⅲ级损伤患者术后发生十二指肠瘘5例，胰瘘3例，均经VSD后自行闭合；Ⅳ和Ⅴ级损伤患者术后VSD持续引流出十二指肠液和胰液，待引流管周围瘘道完整后，再次手术行空肠一瘘道间Roux-en-Y吻合；随访6个月至15年，无腹腔感染、腹腔积液、胰腺假性囊肿、肠梗阻等并发症发生。结论：对于病情危重、难以耐受复杂手术的胰腺十二指肠损伤患者，可优先选择简单胰腺十二指肠创面处理加VSD进行治疗。Objective： To assess the value of abdominal vacuum sealing drainage （VSD） in treatment of severe pancreatic- duodenal injuries. Methods： The clinical data of 16 patients with severe pancreatic-duodenal injury admitted during January 1998 and January 2013 were retrospectively analyzed. Injuries of the patients were graded according to AAST injury grading system as grade Ⅲ in 10 cases, grade IV in 4 cases, and grade V in 2 cases, respectively. Results： The patients were subject to only debridement and hemostasis of wound surface for pancreatic lacerations, one-layered suture closure of duodenal lacerations, relevant treatments for the associated injuries,and then VSD of the area around the pancreatic transection and duodenal injury, The operative time ranged from 65 to 235 min with an average of 126 min. There was no operative death, while one patient was transferred to another hospital due to abdominal bleeding after operation, and the length of hospital stay for abdominal injury in the remaining 15 cases ranged from 16 to 45 d. Of the patients with grade Ⅲ injury, postoperative duodenal fistula occurred in 5 cases and pancreatic fistula occurred in 3 cases, and all of them closed spontaneously after VSD. In patients with grade Ⅳ and Ⅴ injury, pancreatic and duodenal secretions were continuously drained from VSD tube until the formation of a complete fistula tract around the VSD tube, and then a Roux-en-Y anastomosis between the fistula tract and jejunum was performed. Follow-up was variable from 6 months to 15 years, during which, no complications such as intra-abdominal infections, abdominal effusion, pancreatic pseudocyst, or intestinal obstruction were noted. Conclusion： For patients with severe pancreatic-duodenal injury who are in critical condition, or would not tolerate complex surgery, simple treatment of the pancreatic-duodenal wound surface combined with VSD is recommended.

关 键 词：胰腺 损伤 十二指肠 损伤 肠瘘 胰腺瘘 引流术 

分 类 号：R657.5[医药卫生—外科学]