儿童胰腺损伤的临床诊断和治疗

Clinical diagnosis and treatment for pancreatic injury in children

目的总结儿童胰腺损伤的临床特点,探讨其合理的诊断和治疗方法。方法回顾性分析15年来11例儿童胰腺损伤的临床资料,对儿童胰腺损伤严重程度进行分级,并根据临床随访资料,分析损伤严重程度与治疗方法、治疗成功率的相关性。结果11例4～14岁的儿童诊断为胰腺损伤,包括Ⅰ级损伤2例,Ⅱ级损伤3例,Ⅲ级损伤5例,Ⅳ级损伤1例。7例进行CT检查,5例发现阳性征象。Ⅰ级和Ⅱ级损伤患者均通过非手术治疗愈合。5例Ⅲ级损伤中,3例经非手术治疗,其中1例死亡,余2例继发胰腺假性囊肿,手术治疗愈合；另2例进行远端胰腺切除手术,无并发症治愈。1例Ⅳ继损伤性十二指肠憩室化手术,死亡。结论儿童胰腺损伤应根据诊断时间、损伤类型等因素施行个性化治疗方案。手术后24h重复CT检查有助于早期诊断。对早期诊断的Ⅲ级损伤,远端胰腺切除手术是安全有效的。

Objective To summarize the clinical features of pancreatic injury in children, and to explore the suitable methods for its diagnosis and treatment. Methods A retrospective analysis of children with pancreatic injury within the 15 years was carried out. Clinical injury severity and following-up data were collected. Correlafioaship between injury severity, treatment method and successful rate was analysed. Results Eleven children aged 4 to 14 years old were diagnosed as pancreatic injury： two had Grade Ⅰ injury, three Grade Ⅱ , five Grade Ⅲ, and one Grade Ⅳ. CT scan was used in 7 children, and 5 had positive sign. Patients with Grade Ⅰ and Grade Ⅱ injuries were suecessfully cured without surgery. Three children with Grade Ⅲ injury were initially treated without operation, but two developed a large symptomatic pseudocyst and were cured through operation, and another one died. The other two children with Grade Ⅲ who underwent a distal panereatectomy cured without complications. A patient with Grade Ⅳ injury was treated by Berne operation and died. Conclusion The management of pancreatic injury in children should be individualized depending on diagnosis time and injury type. A repetitive CT scan was helpful within 24h after injury. Distal panereateetomy was a safe and effective for those with Grade Ⅲ injury.