18例医源性创伤性胰腺炎的原因及防治

Reasons for and prevention of iatrogenic traumatic pancreatitis： a report of 18 cases

目的探讨在上腹部手术或经内镜逆行胰胆管造影术（ERCP）后发生医源性创伤性胰腺炎的原因及其防治措施。方法对1992年1月至2006年12月间上海市金山区中心医院收治18例医源性创伤性胰腺炎的临床资料作回顾性分析。结果发生于上腹部胃十二指肠疾病手术后7例、胆道手术后5例、ERCP检查后6例。多发生于术后1～4d。12例保守治疗（66．7％），6例再手术清创引流（33．3％）。1例胆道探查术后、1例ERCP检查后重症胰腺炎经再次手术后死于多脏器功能衰竭，余均治愈。结论在上腹部手术或ERCP检查中出现操作不当或失误是引发术后医源性创伤性胰腺炎的主要原因。术中操作规范、动作轻柔、技术熟练、选用抑制胰酶分泌的药物等是预防术后医源性创伤性胰腺炎发生的主要措施。治疗上应首选保守治疗，如出现病情变化或保守治疗无效则应及时手术。

Objective To investigate the reasons for and preventing measures of iatrogenic traumatic pancreatitis after epigastric operations and ERCP. Methods The clinic data of 18 cases of iatro genic traumatic pancreatitis treated in our hospital from January 1992 to December 2006 were retrospectively analyzed. Results The disease occurred 12 cases after operation and in 6 after ERCP. The iatrogenic traumatic pancreatitis after epigastric operations or ERCP mostly occurred in 1- 4 d after the operation. Twelve patients underwent conservative therapy（66.7 % ） and 6 reoperation（33.3 % ）. Sixteen patients were cured and 2 died of the multiple organ failure after reoperation. Conclusion This complication is related to the operative skill and expertise. The preventing measures include suitable operative handling, proficiency in technique and drug lessening excretion of pancreatic juice. Conservative therapy is of the first choice unless there is a state of illness alteration.