闭合性胰腺损伤的诊断和治疗:附32例报告

Diagnosis and treatment of blunt pancreatic injury:a report of 32 cases

目的探讨闭合性胰腺损伤的早期诊断和治疗方法。方法回顾性分析收治的闭合性胰腺损伤32例的临床资料。结果CT诊断符合率为79.3%。非手术治疗4例,其中I级3例,II级1例。手术治疗28例,I级5例和II级7例行胰周清创外引流术;6例Ⅲ级胰腺损伤中,行远端胰腺切除术和脾切除术4例,行保脾远端胰腺切除术2例;5例Ⅳ级胰腺损伤中,行胰腺空肠Roux-en-Y吻合术4例,行远端胰腺切除术和脾切除术1例;5例Ⅴ级胰腺损伤中,行十二指肠憩室化手术1例,2例胰头严重毁损伤行胰十二指肠切除术,2例由于复合伤情较重,首先应用损伤控制手术,于受伤后48 h再次行彻底性手术。全组死亡3例,死亡原因主要为多器官功能衰竭,余25例中术后发生并发症19例(76.0%),包括胰瘘、胰腺假性囊肿等,均经治疗而愈。结论无明确主胰管损伤、临床情况稳定时,胰腺损伤可先行非手术治疗。手术治疗适于重度闭合性胰腺损伤,根据胰腺损伤的程度选择合理的手术方式可提高治愈率,降低病死率。

Objective To explore the methods for early diagnosis and treatment of blunt pancreatic injury. Methods The clinical data of 32 patients with blunt pancreatic injury treated in our hospital from Janurery 2004 to Janurery 2009 were retrospectively analyzed. Results The conformity diagnosis rate of CT was 79.3%. Four cases received nonoperative treatment including 3 cases of grade Ⅰ and 1 of grade Ⅱ injury. A total of 28 cases with blunt pancreatic injury underwent operation ： 5 grade Ⅰ and 7 grade Ⅱ cases underwent debridement and drainage; among the patients with grade Ⅱ injury, 4 underwent distal pancreatectomy in combination with splenectomy, and 2 pancreatectomy with spleen preservation; amongst the 5 patients with grade IV injury, 4 underwent Roux-en-Y pancreaticojejunostomy and 1 underwent distal pancreatectomy in combination with splenectomy; of the 5 patients with grade V injury, 1 case was operated on using duodenorrhaphy and diverticulization, 2 underwent the Whipple＇s procedare and 2 had damage control surgery. Three patients died of multiple organ failure, and complications occurred in 19 （76.0%）. Pancreatic fistula and pancreatic pseudocysts were the main complications. Conclusions In the absence of major pancreatic duetal injury, and the clinical conditions were stable, pancreatic injuries can be treated with nonoperative management. Operative treatment is suitable for severe blunt pancreatic injury. Appropriate operation, based on patient condition and the classification of panerecatic trauma, is the key to increase the cure rate and decrease mortality rate.