胰腺外伤126例诊治体会

Experiences in Diagnosis and Treatment of Closed Pancreatic Trauma in 126 Cases

目的探讨闭合性胰腺外伤的诊断和治疗方法.方法回顾性分析我院1992年7月至2009年7月收治的126例闭合性胰腺外伤的病例资料,并进行总结.结果126例中,105例予手术治疗,治愈91例(86.7%),95%可信区间为80%～93%,死亡14例(13.3%),95%可信区间为5.61%～16.59%,89例合并其他脏器损伤.56例受伤后6～48h动态测定血、尿淀粉酶,41例呈升高趋势.术前98例行B超检查,发现胰腺外伤32例,经CT检查47例,发现胰腺外伤29例.11例病情较轻者,未合并其他脏器损伤者,经保守治疗后治愈.结论胰腺外伤术前诊断较为困难,结合病史、淀粉酶、B超及CT有助于早期诊断,特别是受伤后6～48h动态测定淀粉酶呈升高趋势,有较高价值.术中探查胰腺仍是诊断胰腺损伤最可靠方法,同时应注意胰腺外伤多合并其他脏器损伤.

Objective To study the diagnosis and treatment of closed pancreatic trauma.Methods Retrospectvely analysis was carried in 126 cases of closed pancreatic trauma from 1992 to 2009 in Kunming Yan＇ an Hospital.Results In all 126 cases,105 cases were given surgery treatment,91 cases（86.7%） were cured and 14 cases（13.3%） died.89 cases had injuries in other organs.Preoperative B-ultrasonography was performed,and 89 cases of pancreas trauma were discovered;56 cases received dynamic monitoring blood and urine amylase after bruise 6 ～48 hours,41 cases showed.98 cases received B examination,32 cases of pancreas trauma were discovered;29 cases of pancreas trauma were found in 47 cases by CT examination.11 cases of minor pancreas traumawithout injuries in other organs were cured.Conclusions The pancreas trauma is difficult to diagnose before operation,history of disease,amylase,B examination CT examination can help to preoperative diagnosis early,especialy dynamic mornitoring blood and urine amylase after bruise 6～48 hours,and Paunch is the best means for early diagnosis,and pancreatic trauma with injuries in other organs should be considered.