胰腺损伤的诊断与外科治疗(附39例报告)

Diagnosis and surgery management of pancreatic injuries:39cases reports

目的探讨胰腺损伤的早期诊断及外科治疗。方法回顾性分析39例胰腺损伤的临床资料。结果术前确诊6例,33例手术探查确诊(腹腔镜下8例)。行清创引流12例(经腹腔镜5例);胰近端缝合胰远端切除13例(保留脾脏3例);胰近端缝合加胰远端空肠吻合13例;十二指肠(改良)憩室化10例,胰十二指肠切除1例。合并伤27例,治愈31例,发生胰瘘6例,腹腔内出血2例,腹腔内感染2例,死亡8例。结论胰腺损伤的术前确诊困难,及时手术探查是早期诊断最简单可靠的方法。对不同程度、类型的损伤,选择恰当的手术方式,是减少其并发症,降低死亡率的关键。应用腹腔镜探查引流避免了部分患者剖腹手术。

Objective:To investigate early diagnostic and therapeutic ways of pancreatic trauma.Methods:39clinical cases with pancreatic trauma were reviewed.Results:6cases were diagnosed preoperatively,33cased in explorative operation,of8in laparoscopic surgery,12patients underwent drainage of pancreatic effusion,of5using laparoscopic techniques.Pancreatic ablation with suture operation was made in26patients.There were31patients cured on postoperation,27cases were diagnosed been with combined injuries.Of all,6cases were found pancreatic fluid leakage,and2intraabdominal hemorrhage,and2intraabdominal infections,and8died.Conclusions:It is very difficult to diagnose pancreatic injuries accurately on preoperation in blunt abdominal trauma.Generally ac-cepted,explorative operation is the simplest and most convinced method to conform final diagnosis and appropriate operative management is key to decrease complication and death rate.Laparoscopic draingage may be a selective way for some patients with distal pancreatic injuries.