闭合性胰腺损伤16例临床分析

Diagnosis and Treatment of 16 Patients with Blunt Pancreatic Injury

目的探讨闭合性胰腺损伤的诊断和治疗方法。方法对福田人民医院1983-2008年共收治的16例闭合性胰腺损伤患者临床资料进行回顾性分析。结果4例非手术治疗,12例手术治疗,其中4例行单纯修补、引流、胰体尾切除术,6例行胰腺近端封闭、远端胰-空肠Roux-en-Y吻合术,2例行十二指肠憩室化手术、与胰十二指肠切除术。治愈14例,死亡2例。死亡原因均为创伤性休克、多脏器损伤、多器官功能衰竭。3例术后发生胰瘘,经充分引流后治愈。结论由于大多数闭合性胰腺损伤的临床表现多无特殊症状和体征,故早期确诊率低和术前漏诊误诊率高,早期诊断时,CT对胰腺实质损伤诊断价值最大,ERCP在理论上最理想,最准确的是早期手术探查。手术方式要根据胰腺损伤的部位,严重程度灵活选择。

Objective To investigate the diagnosis and treatment of blunt pancreatic injury.Methods The clinical data of 16 patients with blunt pancreatic injury from 1983 to 2008 were analyzed retrospectively.Results 4 patients were treated nonoperatively.In 12 cases of operation patients,4 patients received operation of simple repair,drainage and distal pancreatectomy,6 patients administrated proximal pancreatic closure and distal pancreaticojejunostomy（Roux-en-Y）,2 patients administrated Cogbill＇s technique and pancreatic-duodenum ectomy.14 patients were cured,2 patients died from traumatic shock,multipal organ injury and multiple organ failure.3 patients with fistula were cured by sufficient drainage.Conclusion Most of blunt pancreatic injury cases are without specific clinical manifestation,which causes lower confirming ratio and more misdiagnosis before operation.CT scan is the most useful imaging technique for detecting parenchymal lesions in a relatively early phase.ERCP is theoretically the ideal method.The most accurate one is explorative laparotomy.Different surgical procedure should be adopted according to the position and severity of pancreatic injury.