小儿不同级别闭合性胰腺损伤的疗效分析  

Management of blunt pancreatic trauma in children: a report of 42 cases

作　　者：张丹[1] 陈亚军[1] 王增萌[1] 黄心洁[1] 庞文博[1] 沈秋龙[1] 吴东阳[1] 王丽[1] Zhang Dan,Chen Yajun,WangZengmeng,Huang Xinjie,Pang wenbo,Shen Qiulong,Wu Dongyang,Wang Li.(Department of General Surgery,National Center for Childrens Health;Beijng Childrens Hospital,Capital Medical University,Beijng 100045,China. Corresponding author：Chen Yajun, Email：chenyajunmd＠ aliyun. Com)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院普外科,北京市100045

出　　处：《临床小儿外科杂志》2018年第7期523-527,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的初步探讨儿童闭合性胰腺损伤的诊疗思路。方法回顾性分析本院2008年1月至2016年12月收治的42例闭合性胰腺损伤患儿的临床资料,总结其临床特点、治疗经验及预后。结果 42例中,男33例,女9例,年龄1.6~14岁,低级别胰腺损伤(Ⅰ级、Ⅱ级)25例,高级别胰腺损伤(Ⅲ级、Ⅳ级、Ⅴ级)17例。低级别胰腺损伤患儿中,1例死于多发伤导致的多脏器功能衰竭,24例经保守治疗痊愈;高级别胰腺损伤患儿中,1例死于合并肝挫裂伤和下腔静脉撕裂所致的失血性休克后DIC;1例急诊行胰头端胰腺结扎+胰体尾部空肠Roux-Y吻合术,术后出现假性胰腺囊肿,经保守治疗后痊愈;其余15例早期给予保守治疗,对并发顽固假性胰腺囊肿的患儿选取合适的引流手术,效果良好。结论 (1)儿童闭合性胰腺损伤发病率低,症状隐匿,不合并其它组织脏器损伤的单纯性胰腺损伤往往损伤级别较高,更容易延误诊治,腹部超声是良好的筛查手段;(2)单纯的胰腺损伤通常不会危及生命,早期保守治疗,后期针对并发顽固假性胰腺囊肿的患儿,个性化选择合适的引流手术是安全和有效的。Objective To review the management and outcomes of pediatric blunt pancreatic trauma.Methods From January 2008 to December 2016,a total of 42 hospitalized children with blunt pancreatic trauma were reviewed with regards to clinical features,management strategies and outcomes. Results There were33 boys and 9 girls with an age range of 1. 6 to 14 years. The clinical grades of pancreatic injuries were low （Ⅰ-Ⅱ,n = 25） and high （Ⅲ -Ⅴ,n = 17）. One in lowgrade group died of multiple organ dysfunction syndromerelated to complex trauma while the remainder recovered with nonoperative measures. In highgrade group,onedied of disseminated intravascular coagulation （DIC） related to hepatic and inferior vena cava laceration whikeanother underwent emergency proximal pancreas ligation and distal pancreatic jejunostomy. And postoperativepseudocyst was treated nonoperatively. Initial nonoperative management were adopted in 15 children. And closedexternal drainage was applied for intractable pseudocyst. Conclusion Uncommon with a low morbidity and occult symptoms,pediatric blunt pancreatic trauma leads to delayed referral and misdiagnosis. Patients withoutcomplications of other organs often have a higher level of pancreatic injury. Abdominal ultrasound is an idealscreening choice. Minor pancreatic injury,usually not lifethreatening,may be managed nonoperatively and followed by pseudocyst external drainage.

关 键 词：胰腺/损伤 假性胰腺囊肿 囊肿引流术 儿童 

分 类 号：R726.5[医药卫生—儿科]