Ⅲ、Ⅳ级胰腺钝性损伤微创治疗的探讨  

Minimally invasive treatment for crade Ⅲ&Ⅳ blunt pancreatic injuries

作　　者：冯健[1,2] 刘志伟 蔡守旺[1] 辛先磊[1] 陈继业 王鹏飞[1] 任为正[1] 何蕾[1] 马焕先[1] Feng Jian;Liu Zhiwei;Cai Shouwang;Xin Xianlei;Chen Jiye;Wang Pengfei;Ren Weizheng;He Lei;Ma Huanxian(Faculty of Hepatobiliary and Pancreatic Surgery,Chinese PLA General Hospital,Beijing 100853,China;Department of Hepatobiliary and Pancreatic Surgery,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]解放军总医院肝胆胰外科医学部,北京100853 [2]北京大学首钢医院肝胆胰外科,100144

出　　处：《中华肝胆外科杂志》2021年第12期909-912,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨Ⅲ、Ⅳ级胰腺钝性损伤微创治疗的策略及疗效。方法回顾性分析2011年7月至2019年6月解放军总医院收治的13例采用微创治疗的Ⅲ、Ⅳ级胰腺钝性损伤患者的临床资料,其中男性10例,女性3例,年龄(38±9)岁。微创治疗方法包括经皮穿刺置管引流术(PCD)和经皮肾镜腹膜后入路坏死组织清除引流术(MARPN)。记录分析患者的临床资料。结果13例患者中Ⅲ级损伤者9例,Ⅳ级损伤者4例。13例患者早期均采用保守治疗,保守治疗后13例均出现局部并发症;局部并发症采用微创治疗的策略。13例患者均首先行PCD,PCD的中位干预时间为外伤后25 d;其中10例进一步行MARPN,MARPN的中位干预时间为外伤后41 d。12例患者痊愈出院,1例死亡,死亡率为7.7%(1/13)。术后中位住院时间为19 d。结论对于循环稳定,不伴空腔脏器损伤的Ⅲ、Ⅳ级胰腺损伤,可以考虑采取早期保守治疗、后期并发症MARPN微创治疗的策略。ObjectiveTo explore the strategy and efficacy using minimally invasive treatment for gradeⅢ&Ⅳblunt pancreatic injuries.MethodsRetrospective data retrieved from medical records of 13 patients with gradeⅢ&Ⅳblunt pancreatic injuries who underwent minimally invasive treatment at the Chinese PLA General Hospital from July 2011 to June 2019 were analysed.There were 10 males and 3 females,aged(38±9)years.Minimally invasive treatment included percutaneous catheter drainage(PCD)and minimal-access retroperitoneal pancreatic necrosectomy(MARPN).Date from enrolled patients were anylsed.ResultsThere were 9 patients suffering from gradeⅢinjuries and 4 patients suffering from gradeⅣinjuries.On initial conservative treatment of these 13 patients,all developed local complications.The local complications were treated using minimally invasive treatment strategies:13 patients underwent PCD.The median intervention time for PCD was 25 days after trauma;10 patients were further treated with MARPN,and the median intervention time of MARPN was 41 days after trauma.Twelve patients recovered well and were discharged home.One patient died.The mortality rate was 7.7%(1/13).The median postoperative hospital stay was 19 days.ConclusionFor patients with pancreatic gradeⅢ&Ⅳinjuries who were hemodynamically stable and had no other associated gastrointestinal injuries,initial conservative treatment,followed by subsequent minimally invasive treatment based on MARPN technology could be used to treat local complications.

关 键 词：胰腺 创伤和损伤 血流动力学 保守治疗 最小侵入性外科手术 

分 类 号：R657.5[医药卫生—外科学]