闭合性胰腺创伤的临床诊断和治疗研究进展  

Advances in clinical diagnosis and treatment of blunt pancreatic trauma

作　　者：陈京浩 拜云虎 陈系羽 李晓东 杨雁灵 CHEN Jinghao;BAI Yunhu;CHEN Xiyu;LI Xiaodong;YANG Yanling(Department of Hepatobiliary,Pancreatic and Splenic Surgery,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China;Department of General Surgery,988 Hospital of Joint Logistic Support Force,Zhengzhou,Henan 450007,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院肝胆胰脾外科,陕西西安710032 [2]中国人民解放军联勤保障部队第九八八医院普通外科,河南郑州450007

出　　处：《中国普通外科杂志》2024年第3期431-438,共8页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81870415,82000551)。

摘　　要：闭合性胰腺创伤并不常见,其影像学表现不明显,合并多器官损伤相互掩盖,临床体征不明确,往往难以诊断,易误诊、漏诊,故病死率高。闭合性胰腺创伤应结合影像学证据、实验室检查,综合受伤史和临床表现进行诊断。其治疗取决于创伤级别和部位,对于血流动力学稳定的低级别创伤,通常采用非手术治疗方案,包括禁食、全肠外营养、应用生长抑素、抑酸治疗、外引流、胰管支架置入、重复影像学检查以及结合患者具体情况积极处理并发症和合并症等;血流动力学不稳定的患者通常不建议非手术治疗。高级别创伤手术难度大,通常依据“损伤控制”原则,综合患者受伤情况、生理状态及术中实际情况权衡利弊,并结合所在诊疗中心实际能力选择合适的个体化治疗策略,必要时可考虑转往区域性胰腺中心治疗。闭合性胰腺创伤后常见的并发症包括假性囊肿和胰瘘等,术后应尽早使用生长抑素来减少胰液的分泌,预防胰瘘,也可以通过经皮引流置入、内镜下支架置入和内镜下囊肿-胃造口术或囊肿-空肠造口术来处理。胰腺假性囊肿的形成多因术后引流不畅所致,通过适当冲洗和穿刺置管引流便可治愈,很少需要再次手术。笔者结合既往研究文献及所在中国人民解放军空军军医大学第一附属医院治疗经验对闭合性胰腺创伤的临床诊断与治疗进行阐述,旨在提高闭合性胰腺创伤的早期诊断率,更加合理地救治闭合性胰腺创伤。Blunt pancreatic trauma is not common.Its imaging manifestations are inconspicuous,the concomitant multiple organ injuries often mask each other,and clinical signs are ambiguous,making diagnosis challenging,prone to misdiagnosis or missed diagnosis,resulting in a high mortality rate.The diagnosis of blunt pancreatic trauma should be based on imaging evidence,laboratory tests,comprehensive injury history,and clinical manifestations.Treatment depends on the level and location of the trauma.For lowgrade trauma with hemodynamic stability,non-surgical treatment is usually adopted,including fasting,total parenteral nutrition,somatostatin application,acid-suppression therapy,external drainage,pancreatic duct stenting,repeat imaging examinations,and actively managing complications and comorbidities based on the patient's specific condition;non-surgical treatment is generally not recommended for hemodynamically unstable patients.Surgery of high-grade trauma is challenging.Usually,according to the principle of damage control,the pros and cons of the patient's injury severity,physiological state and actual intraoperative situation are weighed,and the appropriate individualized treatment strategy is selected according to the actual capability of the treatment center,with the option of transferring to a regional pancreatic center if necessary.Common complications after blunt pancreatic trauma include pseudocyst and pancreatic fistula.Early use of somatostatin should be employed after surgery to reduce secretion of pancreatic juice and prevent pancreatic fistula.Additionally,percutaneous drainage,endoscopic stent placement,and endoscopic cyst-gastrostomy or cyst-jejunostomy can be used for management.Pseudocyst formation in the pancreas is mainly due to poor postoperative drainage,which can be cured by proper irrigation and puncture catheter drainage,and rarely requires further surgery.The authors elucidate the clinical diagnosis and treatment of blunt pancreatic trauma by combining previous research literature and the treatme

关 键 词：胰腺 创伤 非贯通性/诊断 创伤 非贯通性/治疗 综述 

分 类 号：R657.5[医药卫生—外科学]