胰腺损伤的诊断与治疗

Diagnosis and treatment of pancreatic trauma

目的 :探讨胰腺损伤的诊断与治疗的方法。方法 :分析 1988年 1月至 2 0 0 3年 12月间收治的 2 9例胰腺损伤的诊断与治疗情况。按美国创伤外科学会 (AAST)胰腺损伤分级 :Ⅰ级 6例 ,Ⅱ级 4例 ,Ⅲ级 13例 ,Ⅳ级 3例和Ⅴ级 3例。 2 7例病人经过外科手术治疗。 8例胰腺损伤的病人行局部引流。胰头侧断端胰管结扎闭锁缝合、胰体尾部切除术 9例 (其中经内镜鼻胰管引流术 3例 ;同时因脾脏严重损伤行脾切除 5例 )。胰头侧断端胰管结扎闭锁缝合、体部断端胰空肠Roux Y吻合术 7例。Ⅴ级损伤 3例 ,十二指肠憩室化术 2例 ;行急诊胰十二指肠切除术 1例。结果 :2 3例治愈。 1例发生创伤性胰腺炎经保守治疗恢复正常 ;2例发生胰漏 ,经引流、善宁治疗治愈 ;2例形成胰腺假性囊肿 ,3个月后行胰腺假性囊肿空肠Roux Y吻合术。 1例死于颅脑损伤。结论 :胰腺损伤早期诊断是治疗的关键。术中细致探查十分重要。若病情允许 ,内镜不但有助于胰腺损伤的诊断 ,而且是治疗胰腺损伤的一种有效方法。依据胰腺损伤类型选择合理的治疗方法 。

Objective:To explore and discuss the methods of diagnosis and treatment of the pancreatic trauma.Methods:The methods of diagnosis and management were analyzed retrospectively in 29 patients of pancreatic trauma from January 1988 to December 2003. According to the classification of the pancreatic damage of the American Association for the Surgery of Trauma,6 cases were grade Ⅰ,4 cases grade Ⅱ,13 cases grade Ⅲ,3 cases grade Ⅳ and 3 cases grade Ⅴ. Twenty-seven patients were undergone surgical treatment. Local drainage was performed in 8 cases of the pancreatic trauma. Broken end of the pancreatic duct was ligatured and closed with suture and the pancreatic tail was excised in 9 cases(of whom,endoscopic nasal pancreatic drainage(ENPD) was performed in 3 cases,at the same time,splenectomy was performed in 5 cases because of severe trauma of the pancreas). Seven cases were undergone ligature,closure and suture at the broken end of the pancreatic duct in the pancreatic head and Roux-Y pancreaticojejunostomy at the broken end of the pancreatic body. In 3 cases of grade Ⅴ damage,duodenal diverticulization was performed in 2 cases and emergency pancreaticoduodenectomy in 1 patient.Results:23 patients were cured. One case of traumatic pancreatitis was restored to normal through conservative therapy. Two cases with pancreatic leakage were cured after drainage method and treatment of sandostatin. Two cases with pancreatic pseudocyst were undergone Roux-cystojejunostomy after 3 months. One case died of craniocerebral injury.Conclusion:Pancreatic damage diagnosed preoperatively is very difficult,therefore,early diagnosis is a key of management. The careful exploration during operation is of importance. The endoscopic retrograde cholangiopancreatography(ERCP) is not only a valuable adjunctive diagnostic tool,but is an effective therapeutic method if the patient's condition is permitted. Selecting a reasonable operative procedure can reduce the postoperative complication according to the type of the pancreatic trauma.