中国实用外科杂志

中国实用外科杂志

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危重胰腺外伤专科化治疗8例疗效分析

白雪巍，陈    华，刘    杰，武林枫，孙    备，姜洪池   

  1. 哈尔滨医科大学附属第一医院胰胆外科，黑龙江哈尔滨 150001
  • 出版日期:2015-03-01 发布日期:2015-03-02

  • Online:2015-03-01 Published:2015-03-02

摘要：

目的    分析危重胰腺外伤的临床特点和转诊规律，总结转诊后专科化治疗的经验与体会。方法    收集2013年6月至2014年6月转诊至哈尔滨医科大学附属第一医院的8例病情危重的胰腺外伤病人的临床资料，分析胰腺损伤情况、治疗经过和转诊原因，归纳转诊后专科化治疗的要点、难点以及治疗过程中出现的主要并发症及对策。结果    8例病人中Ⅳ级胰腺损伤2例，Ⅲ级胰腺损伤5例，Ⅱ级胰腺损伤1例，均存在严重的合并伤。转诊前6例在外院行手术治疗，无法控制的腹腔或腹膜后感染是病人转诊的主要原因。转诊后3例病人以经皮穿刺置管引流、胰管支架和内镜下坏死组织清除等微创方式治愈，5例病人再次经历手术治疗。创伤性胰腺炎、肠瘘、腹腔出血和胃排空障碍是治疗期间最主要并发症，8例病人均痊愈出院，平均住院时间87 d。 结论    胰腺外伤发病隐匿，治疗棘手，及时向区域性胰腺中心转诊有助于进一步救治。专业化胰腺外科团队在分析病情、选择和实施微创化、个体化外科干预、提高危重胰腺外伤整体救治率等方面具有优势。

关键词: 胰腺外伤, 感染, 专科化治疗

Abstract:

Specialized treatment of transferred severe pancreatic trauma:A report of 8 patients        BAI Xue-wei，CHEN Hua，LIU Jie，et al. Department of Pancreatic and Biliary Surgery，the First Affiliated Hospital of Harbin Medical University，Harbin 150001，China
Corresponding author：SUN Bei，E-mail：sunbei70@tom.com
Abstract    Objective    To analyze the clinical characteristics and transferal regulation of severe pancreatic trauma，and summarize the experience of specialized treatment. Methods    The clinical data of 8 patients with severe pancreatic trauma transferred from other hospitals between June 2013 and June 2014 in the First Affiliated Hospital of Harbin Medical University were reviewed in terms of the situation of pancreatic trauma，process of treatment and causes of transferal to recapitulate the main and difficult points of specialized treatment as well as major complications during treatment and the managing strategies. Results    All of 8 paitients were combined with associated injury. Among them，2 patients with 4th-degree trauma，5 patients with 3rd-degree trauma and 1 patient with 2nd-degree trauma. Six patients were transferred into the First Affiliated Hospital of Harbin Medical University because of uncontrolled peritoneal/retroperitoneal infection after operation. After transferal，3 patients were cured by minimally invasive approach such as PCD，stent drainage of pancreatic duct and endoscopic necrosectomy. Five patients underwent re-operations. The major complications contain traumatic pancreatitis，intestinal fistula，intra-abdominal hemorrhage and delayed gastric emptying. All of 8 patients were healed after specialized treatment，and the mean hospital stay was 87 days. Conclusion    The pathogenesis of pancreatic trauma is concealed，and the treatment is quite difficult. Timely referral to the regional pancreatic center contributes to further treatment. Professional team of pancreatic surgery has advantages in estimating patients’conditions，selecting and performing individualized and minimally invasive surgical interventions，and  improving the overall cure rate of severe pancreatic trauma.

Key words: pancreatic trauma, infection, specialized treatment