中国实用外科杂志

中国实用外科杂志 ›› 2008, Vol. 28 ›› Issue (09): 753-756.

• 论著 • 上一篇    下一篇

胰腺损伤的诊断和治疗(附15例报告)

张思瑶，刘冰阳，董明，周建平，田雨霖   

  1. 1.中国医科大学附属第一医院普通外科教研室胃肠胰外科，辽宁沈阳110001；2.中国医科大学七年制93期，辽宁沈阳110001
  • 收稿日期:2008-03-01 修回日期:2008-04-01 出版日期:2008-09-10 发布日期:2008-09-10
  • 通讯作者: 董明

Diagnosis and surgical management of pancreatic trauma:a report of 15 cases

<a href="https://www.zgsyz.com/zgsywk/EN/article/advancedSearchResult.do?searchSQL=(((ZHANG Si-yao[Author]) AND 1[Journal]) AND year[Order])" target="_blank">ZHANG Si-yao</a>,<a href="https://www.zgsyz.com/zgsywk/EN/article/advancedSearchResult.do?searchSQL=(((LIU Bing-yang[Author]) AND 1[Journal]) AND year[Order])" target="_blank">LIU Bing-yang</a>,<a href="https://www.zgsyz.com/zgsywk/EN/article/advancedSearchResult.do?searchSQL=(((DONG Ming[Author]) AND 1[Journal]) AND year[Order])" target="_blank">DONG Ming</a>,<a href="https://www.zgsyz.com/zgsywk/EN/article/advancedSearchResult.do?searchSQL=(((et al.[Author]) AND 1[Journal]) AND year[Order])" target="_blank">et al.</a>   

  1. Department of General Surgery,the First Hospital,China Medical University,Shenyang 110001,China
  • Received:2008-03-01 Revised:2008-04-01 Online:2008-09-10 Published:2008-09-10
  • Contact: DONG Ming

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摘要：

目的:探讨胰腺损伤的诊断与治疗经验。方法:分析自2002年4月至2007年2月间中国医科大学附属第一医院普通外科收治的15例胰腺损伤的临床资料情况。按美国创伤外科学会(AAST)以及术中探查所见胰腺损伤分级：Ⅰ级2例，Ⅱ7例，Ⅲ级3例。Ⅳ级2例和Ⅴ级1例。5例行非手术治疗。10例病人经过手术治疗：胰头血肿清创止血、腹腔多管引流1例；胰头颈部破裂缝合修补、胰周引流术4例；胰头侧断端胰管结扎闭锁缝合、胰体尾部切除术3例；胰头侧断端胰管结扎闭锁缝合、体部断端胰空肠Roux-en-Y吻合术2例。结果:12例治愈。其中1例发生创伤性胰腺炎，2例发生胰漏，经引流、胰酶抑制剂、抗炎等治疗治愈。2例好转,腹痛症状较前减轻，血淀粉酶降至正常范围。1例因多发创伤死亡。结论:早期诊断、准确掌握手术时机、必要时果断开腹仔细探查是治疗胰腺损伤的关键。依据胰腺损伤类型选择合理的术式与充分引流，可以有效提高治愈率并减少术后并发症。

关键词: 胰腺, 损伤

Abstract:

Objective:To discuss the experience of diagnosis and surgical treatment of pancreatic trauma. Methods:The clinical data of 15 patients with pancreatic trauma treated surgically from April 2002 to February 2007 in the First Hospital of China Medical University were analyzed.According to American Association for the Surgery of TraumaOrgan Injury Scale (AAST-OIS)，2 cases were in gradeⅠ,7 in grade Ⅱ,3 in grade Ⅲ,2 in grade Ⅳ,and 1 in grade Ⅴ.Five patients received nonsurgery treatments.Ten patients underwent surgeries including débridement and hemostasis of hematoma in pancreatic head and intraperitoneal drainage with multiple tubes in 1 case,suturing and repairing rapture in pancreatic neck also drainage around in 4 cases,ligature of pancreatic duct and suture repair of the pancreatic head with resection of the distal pancreas in 3 cases,and ligature of pancreatic duct and suture repair of the pancreatic head with Roux-en-Y distal pancreaticojejunostomy in 2 cases. Results:Twelve patients fully recovered.Of them,1 developed the pancreatitis and 2 suffered from the pancreatic leakage.These 3 cases recovered with conservative treatment including using pancreas enzyme inhibitor.For remaining 3 cases，2 improved and 1 died of multiple trauma. Conclusion:Early diagnosis and the carefully surgical exploration were the key for treating pancreatic trauma.According to the grade of the pancreatic trauma,reasonable choice of surgical manner might increase cure rate and reduce the postoperative complications.

Key words: pancreas, trauma