胰腺十二指肠损伤的诊治体会

THE EXPERIENCE OF DIAGNOSIS AND TREATMENT OF PANCREAS AND DUODENUM’S INJURY

目的探讨胰腺、十二指肠损伤的诊断及治疗经验。方法回顾性分析45例胰腺、十二指肠损伤患者,包括26例胰腺损伤、13例十二指肠损伤及6例胰十二指肠复合伤的临床资料。结果45例患者中33例(73.3%)合并伴发伤;CT诊断符合率为72.7%(8/11);4例保守治疗,41例行手术治疗;共21例(46.7%)出现并发症,其中胰瘘9例;治愈38例(84.4%),7例死亡(15.6%)。结论本病早期诊断困难,伴发伤多,并发症发生率及死亡率高。剖腹探查是诊断胰十二指肠损伤的主要方法,根据损伤部位、程度及全身情况选择合理术式,术后积极防治并发症是提高治愈的关键。

Objective To investigate the diagnosis and treatment of pancreatic duodenal trauma. Methods Clinical data of 45 cases with pancreatic duodenal injury were retrospectively analyzed. There were 26 cases of ancreatic trauma, 13 cases of duodenal trauma and 6 cases of pancreaticoduodenal injuries. Results Among the 45 patients,33 cases（73.3% ） were associated with other organ injuries. The accordance rate of CT diagnosis was 72. 7（8/11 ）. Operation was performed in 41 cases,and the other 4 cases were healed by conservative treatment. Complications were occurred on 21 cases （46.7%） ,which included 9 cases of pancreas fistula. 38 cases were cured （ 84.4% ） ;and 7 died（ 15.6% ）. Conclusion Early diagnosis of pancreatic duodenal trauma is difficult, the rates of complication morbidity and mortality were high. Exploratory celiotomy is the most reliable method for diagnosing pancreatic duodenal trauma. The rational surgical procedures to be performed is usually decided according to the injury location, severity and the patient＇s general condition, and postoperative complications should be treated promptly.