损伤控制剖腹术治疗严重胰腺损伤19例

Damage control operation for severe pancreatic trauma: a retrospective analysis of 19 cases

目的总结损伤控制剖腹术(dam age control laparotomy,DCL)治疗严重胰腺损伤的经验。方法回顾性分析采用DCL治疗的19例严重胰腺损伤患者的手术方式选择和后续治疗情况。结果6例行快速止血、清创及引流(32%),3例行改良Cogb ill手术(16%),10例行消化道未重建的胰十二指肠切除(53%)。SICU复苏后,所有患者均接受再次确定性手术。死亡2例(11%),死亡原因与手术无关;治愈17例(89%),术后出现胰瘘2例(11%),经保守治疗痊愈。结论符合DCL指征的严重胰腺损伤的患者,应根据不同损伤胰腺部位和程度,积极选用适宜的方式,分次手术治疗。

Objective To explore the currem management strategy and effect of damage control operation （DCO）for severe pancreatic trauma. Methods The clinical data of 19 cases with severe pancreatic trauma were selected as the object of this study. A retrospective analysis was done on preference of DCO moduses and perioperative therapies. Results Operations were performed in all 19 patients including six cases （32%） treated with rapid surgical haemorrhage control, wound excision and drainage, three （11%） with Cogbill operation and 10 （53%） with Whipple operation without reconstituted digestive tract. Then, all cases were under reoperations after SICU resuscitation. Death was caused by associated organs injuries and secondary infection, with mortality rate of 11%. The pancreatic fistula occurred in two cases （ 11% ） that were healed by conservative treatments. Conclusion For severe pancreatic trauma cases in accordance with DCO indications, active and reasonable operation should be done according to location and degree of pancreas injury.