胰腺损伤的临床特点及术式探讨

Exploration of the Clinical Features and Operative Procedure in Pancreatic Trauma

目的:探讨胰腺损伤的临床特点及手术方式。方法:回顾性分析48例胰腺损伤患者的临床资料。其中闭合性损伤42例,开放性损伤6例。Ⅰ级胰腺损伤12例,Ⅱ级22例,Ⅲ级10例,Ⅳ级3例,Ⅴ级1例。42例(88%) 合并有腹内其它脏器损伤。结果:全组仅23例术前明确诊断。手术治疗44例,非手术治疗4例。19例发生并发症, 43例治愈,5例(11%)死亡。结论:胰腺损伤具有合并伤多、病情重,术前确诊率低,术后并发症发生率高。死亡原因主要与严重的合并伤有关。淀粉酶测定可以作为诊断的线索,术中判断有无主胰管损伤是手术治疗的关键。

Objective： To investigate the clinical features and operative procedure of acute pancreatic injuries. Methods： The clinical data of 48 patients with pancreatic injuries were analyzed retrospectively, in which there were blunt trauma 42 cases, penetrating trauma 6 cases. There were 12 cases in grade Ⅰ , 22 in grade Ⅱ, 10 in grade Ⅲ, 3 in grade Ⅳ and 1 in grade Ⅴ. 42 cases （88%） were combined with other trauma in abdominal organs. Results： The correct diagnosis was made only in 23 cases preoperatively. The complications occurred in 19 cases.44 cases received operative treatment, while only 4 cases received non-operative treatment. 43 cases were cured, 5 cases （11%） died eventually. Conclusion： The clinical features of acute pancreatic injuries were multiple associated injuries, the severe condition, lower rate of preoperative diagnosis and higher rate of postoperative complications. The main cause of death of acute pancreatic injuries was due to the severe concomitant injuries. The amylase determination might give come clue to make further examinations. The most important determinant in managing acute pancreatic injuries were the integrity of the major pancreatic duct.