73例创伤性胰腺炎的专科化治疗体会  

h e Experience of Specialized Treatment of 73 Cases of Traumatic Pancreatitis

作　　者：白雪巍[1] 丁乙轩 陈华[1] 刘杰[1] 武林枫[1] 姜洪池[1] 孙备[1] 

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,黑龙江哈尔滨150001

出　　处：《中国普外基础与临床杂志》2015年第1期11-17,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金(项目编号:81470887;81100314;81170431;81370565和81372613);教育部高等学校博士学科点专项科研基金(项目编号:20122307110012);卫生公益性行业科研专项经费资助项目(项目编号:201202007);黑龙江省普通高等学校青年学术骨干支持计划项目(项目编号:1155G35);哈尔滨市科技创新人才研究专项基金(项目编号:2010RFQQS059)~~

摘　　要：目的总结胰腺外伤后并发的创伤性胰腺炎（traumatic pancreatitis,TP）的临床特点,阐述专科化治疗体会。方法收集笔者所在医院2008年1月至2014年6月期间诊治的73例TP患者的临床资料,分析胰腺损伤部位、等级以及TP的发病因素,归纳TP病程中的共性问题及规律,总结TP的治疗策略、外科干预方法以及手术要点和难点。结果本组病例的胰腺损伤以2、3、4级为主,胰头部损伤占31.5%（23/73）,胰颈体尾部损伤占68.5%（50/73）;59例来自外院转诊;伤后4~7 d是发生TP的高峰期,胰瘘及难以控制的腹腔感染是TP的治疗难点;经皮穿刺置管引流、放置胰管支架和内镜下脓肿清除是TP有效的微创化治疗方法;42例TP患者需要再次手术治疗,其中19例经历2次以上手术。结论 TP病情复杂多变、治疗棘手,早期明确诊断、制定正确的外科干预策略是治疗的关键;专业化的胰腺团队在判断病情、选择和实施外科干预时更有优势。Objective To summarize the clinical characteristics of traumatic pancreatitis （TP） after pancreatic trauma and illustrate the experience of specialized treatment. Methods Clinical data of 73 patients with TP treated in our hospital from January 2008 to June 2014 were collected. The pancreatic injury location, grade, and TP pathogenic factors were analyzed, summarized the common problem and the regularity in TP course, and summarized the treatment strategy, methods of surgical intervention, operation key points and difficulties of TP. Results The grade of pancreatic trauma in the all of patients was mainly to levels of 2, 3, and 4, the head of the pancreas injury accounted for 31.5% （23/73）, cervical pancreatic body and tail injuries accounted for 68.5% （50/73）. Fifty-nine patients were from other hospitals referral. The occurrence of TP peak period was 4-7 days after pancreatic trauma. Pancreatic fistula and uncontrolled peritoneal infection were the treatment difficulty of TP. It＇s the effective minimally invasive treatment methods for TP that percutaneous catheter drainage, pancreatic duct stent placement, and endoscopic abscess debridement. Forty-two patients with TP needed reoperations, and 19 cases underwent more than 2 times operation. Conclusions Because of the condition of TP is complex and changeable, and difficulty to treat, so the early definitive diagnosis and appropriate surgical strategy play a crucial role in the treatment of TP. Besides, professional team of pancreatic surgery has advantages in estimating patients＇ conditions, selecting and performing surgical interventions.

关 键 词：胰腺外伤 创伤性胰腺炎 胰瘘 诊断 治疗 

分 类 号：R657.51[医药卫生—外科学]