创伤性胰腺损伤12例外科治疗分析  

Surgical treatments of traumatic pancreatic injury:a report of 12 cases

作　　者：茹皓 刘畅[1] 董泽鹏 孙学军[1] 孙祺 Ru Hao;Liu Chang;Dong Zepeng;Sun Xuejun;Sun Qi(Department of General Surgery,First Affiliated Hospital,Xi'an Jiaotong University,Shaanxi Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院普通外科,陕西西安710061

出　　处：《腹部外科》2024年第3期212-215,225,共5页Journal of Abdominal Surgery

基　　金：国家自然科学基金资助项目(81702362)。

摘　　要：目的探讨外伤所致闭合性腹部损伤中胰腺损伤的外科治疗方法。方法回顾性收集2018年1月至2023年8月西安交通大学第一附属医院收治并行外科治疗的12例创伤性胰腺损伤病人的临床资料,从受伤原因、诊断方法、外科治疗方法、并发症等方面进行分析。结果12例胰腺损伤病人的受伤方式:交通伤8例,撞击伤4例。胰腺损伤分级:Ⅱ级2例,Ⅲ级6例,Ⅳ级1例,Ⅴ级3例。8例病人术前行血清淀粉酶测定,其中6例血清淀粉酶升高。10例病人术前CT检查诊断胰腺损伤。所有病人均行手术治疗,其中行腹腔积血清除1例,腹腔积血清除术加胰腺修补术1例,胰体尾切除术6例(其中同时行脾脏切除4例),行胰腺坏死组织清除加胰液外引流术并于1年后行二期胰肠吻合术1例,胰十二指肠切除2例,行肠系膜上静脉修补加胰腺坏死组织清除加腹腔置管通畅引流术1例。所有病人中,死于多器官功能衰竭1例,发生术后并发症4例,其中胰瘘2例,腹腔感染2例。结论闭合性腹部损伤病人行CT检查是早期诊断胰腺损伤的重要方式,早期进行分级有助于手术方式的选择决策。经术前检查提示胰腺高级别损伤者应在生命体征维持平稳的前提下及时行手术治疗,选择合理的手术方式及术后通畅引流是防止术后并发症的关键。Objective To explore the surgical treatments for traumatic pancreatic injury in blunt abdominal trauma.Methods From January 2018 to August 2023,the relevant clinical data were retrospectively reviewed for 12 cases of traumatic pancreatic injury.Underlying causes,diagnostic modes,surgical outcomes and major complications were examined.Results The causes of traumatic pancreatic trauma were traffic accident(n=8)and crush(n=4).According to the scale of American Association for the Surgery of Trauma(AAST)for pancreatic trauma,the clinical grades wereⅡ(n=2),Ⅲ(n=6),Ⅳ(n=1)andⅤ(n=3).Among 8 cases of preoperative serum amylase examination,6 cases had an elevated level.Ten cases received preoperative computed tomography(CT)scan.All of them were operated,including removal of peripancreatic hematoma(n=1),removal of peripancreatic hematoma&pancreatic injury repair(n=1),distal pancreatectomy(n=2),distal pancreatectomy plus splenectomy(n=4),pancreatic necrosectomy plus pancreatic external drainage(n=1),pancreatoduodenectomy(n=2)and pancreatic necrosectomy and peripancreatic drainage plus superior mesenteric vein repair pancreatic rupture repair(n=1).The outcomes were mortality(n=1),pancreatic fistula(n=2)and intra-abdominal infection(n=2).Conclusion Preoperative CT scan is a vital diagnostic tool of pancreatic trauma in blunt abdominal trauma and an early classification aids in decision-making of surgical approaches.Surgical intervention should be performed as early as possible for highgrade pancreatic trauma under the premise of stable vital signs.Correct surgical approaches and sufficient drainage are essential for preventing postoperative complications.

关 键 词：闭合性腹部损伤 胰腺损伤 外科治疗 

分 类 号：R657.5[医药卫生—外科学]