胰腺损伤42例回顾分析

The study on the diagnosis and treatment of pancreas injures

目的探讨胰腺损伤的诊断和治疗方法。方法回顾性分析1998～2003年收治的42例胰腺损伤的临床资料。结果胰腺损伤Ⅰ级4例,Ⅱ级14例,Ⅲ级15例,Ⅳ级6例,Ⅴ级3例。结果:术前确诊8例,其余34例术中确诊。保守治疗4例,行单纯外引流12例,胰头侧缝合加胰尾脾切除12例,胰头侧缝合、胰体尾侧断端与胃吻合10例,胰十二指肠切除术2例,十二指肠憩室化2例,死亡2例。结论术前确诊胰腺损伤较为困难,术前磁共振胰胆管造影检查可提高诊断率。对怀疑或诊断为胰腺损伤者,尽早手术探查,选择恰当的手术方式,可有效地减少其并发症,降低死亡率。

Objective To study the diagnosis and treatment of pancreas injuries.Methods 42 cases of pancreas injuries from 1998 to 2003 were reviewed and ananlyzed retrospectively.Results In all cases of pancreas injuries there were 4 cases in grade 1,14 cases in grade 2,15 cases in grade 3,6 cases in grade 4,3 cases in grade 5.8 cases were diagnosed before operation,and the others were diagnosed at operation.4 cases underwent conservation treatment,simple external drainage were made in 12 cases,proximal closure of pancreas plus splenectomy in 12 cases,proximal closure of pancreas and distal pancreaticostomachostomy in 10 cases,pancreatectomy in 2 cases,duodeno-diverticularzation in 2 cases.2 cases died.Conclusions It is difficult to diagnose pancreatic injury before operation.MRCP before operation could increase the rate of diagnosis.If one is suspected or diagnosed with pancreatic injury,it must be operated as soon as possible.According to different degree and type of pancreatic injury and general condition of patients,appropriate operation should be chosen,which can reduce the morbidity of complications and mortality of pancreatic injury.