胰腺损伤77例临床诊治分析  

The Analysis of Clinical Diagnosis and Treatment of 77 Cases of Pancreatic Injury

作　　者：吕瑞昌 尚培中[1] 李晓武[1] 苗建军[1] 刘冰[1] LV Rui-chang;SHANG Pei-zhong;LI Xiao-wu;MIAO Jian-jun;LIU Bing(Department of General Surgery,The 81 st Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院普通外科,河北张家口075000

出　　处：《河北北方学院学报（自然科学版）》2023年第4期24-29,共6页Journal of Hebei North University:Natural Science Edition

基　　金：张家口市大健康和生物医疗专项重点研发计划项目(No.2021058D);中国人民解放军陆军第八十一集团军医院2022年度院级课题(No.6)。

摘　　要：目的回顾收治胰腺损伤患者的临床资料,分析其临床表现、诊断、治疗方法及临床效果,为提高胰腺损伤的诊断率、治愈率提供参考。方法回顾性分析77例胰腺损伤患者的年龄、性别、损伤特征及分级、检查及检验结果、术中情况、治疗方式及效果等,分析胰腺损伤的临床发病特征及处理方式等。结果77例患者中腹部钝性闭合伤71例(92.2%)。伤后6~12 h入院患者血清淀粉酶和脂肪酶平均值明显高于伤后<6 h入院患者。MSCT检查65例,阳性率84.6%(55/65);B超检查42例,阳性率为38.1%(16/42)。AAST-OISⅠ级23例,Ⅱ级18例,Ⅲ级17例,Ⅳ级9例,Ⅴ级10例。非手术治疗30例,其中2例出现假性囊肿,未行特殊处理3月内自行吸收;手术治疗47例,发生胰漏6例,采用双套管持续负压灌洗、鼻空肠营养管持续给予肠内营养,疗效良好。Ⅴ级损伤术中并发大出血死亡1例。结论胰腺损伤的诊断主要依据平扫与增强相结合的动态MSCT,血清淀粉酶、脂肪酶水平值升高有一定参考意义。非手术治疗或手术治疗需依据血流动力学是否稳定、是否合并其他脏器损伤及AAST-OIS分级,手术方式主要依据AAST-OIS分级确定。建立胰漏三级预防理念、术后双套管灌洗引流、早期肠内营养干预可有效降低手术并发症,提高胰腺损伤治愈率。Objective To review the clinical data of patients with pancreatic injury and analyze their clinical manifestations,diagnosis,treatment methods,and clinical results,in order to provide reference for improving the diagnosis and cure rate of pancreatic injury.Methods Age,gender,injury characteristics and grading,examination and test results,intraoperative condition,treatment methods and effects of 77 patients with pancreatic injury were retrospectively analyzed,and the clinical onset characteristics and management methods of pancreatic injury were analyzed.Results There were 71 cases with blunt closed abdominal injuries out of 77 patients(92.2%).The average values of serum amylase and lipase in patients admitted 6 to 12 hours after pancreatic injury were significantly higher than those in patients admitted less than 6 hours after pancreatic injury.MSCT examination was performed in 65 cases,with a positive rate of 84.6%(55/65);42 cases were examined by ultrasound,with a positive rate of 38.1%(16/42).There were 23 cases of AAST-OIS grade I,18 cases of grade II,17 cases of grade III,9 cases of grade IV,and 10 cases of grade V.30 cases underwent non-surgical treatment,of which 2 cases developed pseudocysts that were spontaneously absorbed within 3 months without special treatment.47 cases underwent surgical treatment,with 6 cases experiencing pancreatic leakage;Double cannula continuous negative pressure irrigation and nasal jejunal nutrition tube continuous enteral nutrition were used,and the therapeutic effect was good.One case died of severe bleeding during surgery for Grade V injury.Conclusion The diagnosis of pancreatic injury is mainly based on dynamic MSCT combined with plain scan and enhancement,and the elevated levels of serum amylase and lipase have certain reference significance.Non surgical or surgical treatment should be based on whether hemodynamics are stable,whether other organ injuries are combined,and AAST-OIS grading.The surgical method is mainly determined based on AAST-OIS grading.Establishing a thr

关 键 词：胰腺损伤 MSCT 血清淀粉酶 脂肪酶 AAST-OIS分级 

分 类 号：R657.5[医药卫生—外科学]