小儿闭合性胰、十二指肠严重外伤的外科处理（附12例报告）

Operation for serious Closed Pancreatoduodenal Injury on Children. A Report of 12 Cases

探讨小儿闭合性胰、十二指肠严重外伤的诊治特点。本组小儿闭合性胰断裂２例，十二指肠破裂４例，胰、十二指肠复合伤６例。手术探查并采取远端胰切除及十二指肠“憩室化”（Ｂｅｒｎｅ１９７４年首先提出，其手术方法为：修补十二指肠损伤，切除胃窦，关闭十二指肠，行胃空肠吻合术。同时可行胆总管Ｔ型管引流，再作十二指肠插管造口术及双侧迷走神经干切断术）。３例术前确诊，另９例为手术探查后确诊。治愈８例，死亡４例，其中２例与术式选择不当有关。术前确诊困难，主张早期探查。推荐注射美蓝法寻找断裂胰管。根据不同伤情选择创伤小、安全可靠的术式。

Two cases of pancreatic transection, 4 of duodenal ruptures and 6 of combined pancreato-duodenal injuries are reported. Various operations including distal pancreatectomy and duodenal diverticulectomy were done. Correct diagnosis was made preoperatively in three cases while in the other 9 was made during exploration, Eight cases recovered and 4 died. The cause of two deaths was related to inappropriate operation. Early laparotomy is suggested. Because the diagnosis is difficult to confirm, preoperatively injection of methylene blue is recommended to search for leakage of pancreatic duct. The surgical procedure should be selected according to the underlying pathological conditions.