胰腺十二指肠联合损伤的诊断和治疗

Diagnosis and treatment of pancreaticoduodenal combined trauma

目的探讨胰腺十二指肠联合损伤的诊断和治疗方法,以提高临床疗效。方法回顾性分析11例胰腺十二指肠联合损伤的临床资料。胰头十二指肠联合损伤7例,胰体十二指肠联合损伤4例;全组施行胰十二指肠切除术2例,胰头、十二指肠修补术5例(包括胰头修补+十二指肠修补术1例,胰头修补+带蒂空肠瓣十二指肠修复术2例,胰头、十二指肠修补+十二指肠憩室化手术2例);胰体尾部修补+十二指肠修补术1例,带脾脏胰体尾部切除+十二指肠修补术1例,胰体尾切除+十二指肠切除+空肠十二指肠端端吻合术2例。结果术后3例发生胰漏(27.3%),经持续低负吸引治愈。全组9例痊愈(81.8%),2例死亡(18.2%)。结论早期诊断、及时手术以及正确的手术方式是治疗成功的关键。

Objective To explore the diagnosis and treatment of pancreaticoduodenal combined trauma for improving clinical therapeautic effect. Methods Clinical data of pancreaticoduodenal combined trauma in 11 cases were analyzed retrospectively. Head of pancreas with duodenal combined trauma occurred in seven cases, body-tail of pancreas with duodenal conbined trauma in 4 cases. Pancreatoduodenectomy was performed in 2 cases, suture head of pancreas and duodenorrhaphy were performed in 5 cases, including suture pancreatic head and duodenum in 1 case, suture head pancreatic and duodenorrhaphy by jejunal petal with vascular in 2 cases, suture head of pancreatic and duodenum and duodenal diverticularization in 2 cases. Suture body-tail of pancreas and duodenorrhaphy in 1 case, body-tail pancreatectomy with spleen and duodenorrhaphy in 1 case, body-tail pancreatectomy and duodenectomy with end to end duodenojejunostomy in 2 cases. Results Postoperative pancreatic fistula in 3 cases （27.3%） was cured by continuing lower pressure suction. Of all cases, 9 cases were cured （81.8%） and 2 cases died （18.2%）. Conclusion Early diagnosis, operation in time and correct operative fashion are the key of successful treatment.