胰十二指肠损伤的临床特点及术后并发症危险因素分析

Analysis on the risk factors of postoperative complications and clinical characteristics of pancreaticoduodenal injuries

目的探讨胰十二指肠损伤的临床特点及术后并发症发生的危险因素。方法回顾性分析47例外伤性胰十二指肠损伤手术病例的临床特点,探讨年龄、术前/术中休克、胰十二指肠联合损伤、确诊时间及ISS、APACHEⅡ评分等因素与术后并发症发生率、死亡率的关系。结果47例病例中,腹部闭合性损伤占76.60%,开放性损伤23.40%,多发伤40.43%。胰腺损伤13例,十二指肠损伤28例,胰十二指肠联合损伤6例。术前确诊率为53.19%,手术诊断率97.87%,确诊时间(7.85±3.17)h。术后并发症发生率和死亡率分别为27.66%和8.51%。并发症组的术前/术中休克发生率、胰十二指肠联合损伤发生率、确诊时间、ISS、APACHEⅡ评分分别为53.85%、38.46%、(9.78±2.16)h、20.92±8.11、10.32±3.16,无并发症组分别为11.76%、2.94%、(6.81±2.35)h、16.47±5.28、7.12±2.74,组间差异均有统计学意义(P<0.01或<0.05)。死亡组ISS、APACHEⅡ评分值分别为29.17±10.31、14.75±5.37,显著高于无死亡组的16.85±6.73、8.39±3.13(P<0.01)。结论胰十二指肠损伤在病史、实验室及影像学检查方面具有其特点,综合分析有利于迅速明确诊断,休克、胰十二指肠联合损伤、确诊时间及高ISS、APACHEⅡ评分是其术后并发症发生的危险因素。

Objective To investigate the risk factors of postoperative complications and the clinical characteristics of pancreaticoduodenal injuries. Methods The clinical characteristics of the 47 cases of pancreaticoduodenal injuries were retrospectively analyzed during the period of jun. 1996 - Jun. 2006 and the correlation between the age, shock,time of diagnosis,combined pancreatoduodenal injuries, ISS,APACHE Ⅱ scoring and the postoperative morbidity,mortality were studied. Results In the 47 cases,the percentage of the blunt abdominal injury was 76.60 % and the open abdominal injury 23.40 % respectively. According to the characteristics of history, laboratory and image test, the rate of preoperative diagnosis was 53.19 % ,the rate of operative diagnosis was 23.40 % ,and the mean time of diagnosis was （7.85 ± 3.17）h. There were 13 eases of the pancreatic injury,28 cases of duodenal injury and 6 cases of the combined pancreaticoduodenal injuries,and 40.43 % of the cases suffered from multiple trauma. The morbidity and mortality was 27.66% and 8.51% respectively. In the complication group, the rate of shock and combined pancreaticoduodenal injuries, time of diagnosis, score of ISS and APACHE Ⅱ were 53.85 % ,38.46 %, （9.78 ± 2.16） h, 20.92± 8.11,10.32 ± 3.16 respectively, while in the non - corn plieation group 11.76 %, 2.94 %, （6.81 ± 2,35） h, 16.47 ± 5,28,7.12 ± 2.74 respectively （ P 〈 0.01 or 〈 0.05）. The scores of ISS and APACHE Ⅱ in dead group were 29.17 ± 10.31 and 14.75 ± 5.37 respectively, which were significantly higher than survival group （16.85 ± 6.73 and 8.39 ± 3.13 respec tively, P 〈 0.05）. Conclusion The panereaticoduodenal injuries have the characteristics of history, laboratory and image test. The shock,combined pancreatieoduodenal injuries, time of diagnosis, high score of ISS and APACHE Ⅱ were the risk factors of the postoperative complication in panereaticoduodenal injuries.