胰腺损伤的诊断与治疗(附21例报告)

Diagnosis and Treatment of Pancreatic Injury(A Report of 21 Cases)

目的探讨胰腺损伤的诊断及治疗方法。方法分析1995年1月～2005年12月间收治的21例胰腺损伤的诊断与治疗情况。结果按美国创伤外科学会(AAST)胰腺损伤分级法分级:Ⅰ级4例,Ⅱ级5例,Ⅲ级7例,Ⅳ级3例,Ⅴ级2例。本组均手术治疗,术后发生假性胰腺囊肿2例,胰瘘3例,腹腔脓肿1例,肺部感染2例,切口感染3例;治愈19例,死亡2例。结论胰腺损伤早期诊断是治疗的关键。诊断主要依靠外伤史,CT 检查及腹腔穿刺液淀粉酶检查;剖腹探查是诊断的又一重要手段,术中仔细探查十分重要。治疗以清创、止血、引流、保存胰腺功能为基本原则,根据损伤的程度采用不同的手术方式。

Objective To investigate the principal diagnosis and treatment for pancreatic injury. Methods Retrospective study was made on 21 patients with pancreatic injury from January 1995 to December 2005. Results According to the criteria of the American Association for Surgery Trauma,there were 4 cases of grade Ⅰ ,5 cases of grade Ⅱ ,7 cases of grade Ⅲ ,3 cases of grade Ⅳ and 2 cases of grade Ⅴ. All patients were treated by surgery, 19 cases cured and 2 cases died. Postoperative complications including 2 cases of pancreatic pseudocysts,3 cases of pancreatic fistulas,1 cases of abdominal abscess,2 cases of pneumonia and 3 cases of wound infection. Conclusion Early diagnosis is the key point to treat pancreatic injury. History of injury, CT examination and amylase determination of the ascitic fluid is important for diagnosis. Exploratory laparotomy is another way to confirm diagnosis. The principle of treatment is debridement, homostasis, drainage and save the function of pancreas.