闭合性胰腺损伤22例诊治分析

Diagnosis and treatment of blunt pancreatic trauma

目的提高闭合性胰腺损伤的早期诊断水平,掌握好探查指征,合理选择手术方式。方法回顾性分析20年来22例闭合性胰腺损伤的诊治过程。结果闭合性胰腺损伤临床上均有不同程度的上腹疼痛、呕吐、腹膜刺激征,其中伴休克3例,早期血淀粉酶检查18例,15例阳性;尿淀粉酶12例,6例阳性,腹水淀粉酶检查6例,均为阳性,腹穿12例均为阳性。B超检查18例,确诊9例,CT检查10例,确诊8例。并发症发生率50%(11/22)死亡2例。结论早期诊断闭合性胰腺损伤主要依靠临床表现、诊断性腹腔穿刺、淀粉酶检查和B超及CT检查。各种辅助检查有一定的局限性,术前提高对胰腺损伤程度的认识,掌握好探查指征,合理选择手术方式,可以进一步降低并发症及死亡率。

Objective To improve early diagnosis of blunt pancreati trauma, mastering operative indication and selecting operative program correctly. Methods Retrospective review the diagnosis and treatment of 22 patients with blunt pancreatic trauma in our hospital in the past 20 years. Results The upper abdominal pain was complained in all cases accompanied by nausea, vomiting and slightly or obviously peritoneal irritation. 3 of cases were accompanied by shock. 15 of 18 eases had high level of serum amylase. 6 of 12 cases had high level of urinary amylase. Peritoneal puncture was present in 12 patients. 22 cases had complications and 2 died. Conclusion Early identification of blunt pancreatic trauma relies on clinic symptoms, signs, diagnostic peritoneal puncture, pancreatic amylase, B-us and CT. The result showed that limitations, improving preoperative accessory examination, mastering operative indication and selecting operative program correctly would reduce the complication and mortality.