闭合性胰腺损伤的诊断与治疗

Diagnosis and Treatment of Closed Pancreatic Trauma

目的 探讨闭合性胰腺损伤的诊断和外科治疗方法。方法 对我院收治的 2 6例闭合性胰腺损伤患者的临床资料进行回顾性分析。结果 本组病人均经手术证实 ,轻度挫伤、挫裂伤、横断伤、胰头十二指肠损伤。术前诊断 3例 ,其余 2 3例均为剖腹探查时发现 ,分别行缝扎止血和外引流 ,远端胰腺切除、近端缝合和远端胰腺空肠吻合 ,十二指肠憩室化、胰十二指肠切除。本组发生胰瘘 6例 ,死亡 1例。结论 闭合性胰腺损伤术前确诊困难 ,多数依靠术中探查发现 ,应根据胰腺损伤的部位和程度 。

Objective To investigate the diagnosis andsurgical treatment of closed pancreatic trauma. Methods Twenty-six patients with closed pancreatic trauma were reviewed. Results All patients were confirmed by operation to have pancreatic trauma such as pancreatic simple contusion,laceration,transverse wound, injury on the pancreatic head and duodenum. Preoperative diagnosis was made inonly 3 cases, the others were found in the exploratory laparotomy. The operative methods involved pancreatic repair and external drainage, distal pancreatectomy,proximal pancreatorrhaphy and distal pancreatojejunostomy, duodenaldiverticulization and pancreaticoduodenectomy. Six patients had postoperative pancreatic fistula.One patients died.Conclusion Preoperative diagnosis for closed panereatic trauma is difficult, and in many cases diagnosis can only be established during exploratory laparotomy. Proper operative methods should be made according to the classification ofpancreatic trauma.