闭合性腹部外伤胰腺损伤20例诊断及治疗体会

Diagnosis and Treatment of 20 Blunt Abdominal Trauma Cases with Pancreatic Injury

目的总结胰腺损伤的诊断和治疗经验。方法回顾性分析江阴市人民医院2001年10月—2008年10月收治20例胰腺损伤患者的临床资料。结果据美国创伤协会(AAST)分级标准,其中Ⅰ级3例,Ⅱ级5例,Ⅲ级6例,Ⅳ级5例,Ⅴ级1例。18例手术治疗,术后发生胰瘘6例,假性胰腺囊肿2例,腹腔脓肿3例;治愈18例,死亡2例。结论对腹部闭合性损伤的患者临床医师要保持高度的警惕,应考虑有胰腺损伤的可能。胰腺损伤早期诊断主要依靠外伤史,CT检查及腹腔穿刺液淀粉酶检查。根据MST胰腺损伤分级标准和患者全身情况决定手术方式能明显提高患者的生存率。

[Objective] To summarize the experience in diagnosis and treatment of blunt abdominal trauma.[Methods]The clinical data of 20 blunt abdominal trauma cases in Jiangyin People＇s Hospital from October 2001—October 2008 were retrospectively analyzed.[Results]According to AAST grading criteria, the results were 3 cases of grade Ⅰ, 5 cases of gradeⅡ, 6 cases of gradeⅢ, 5 cases of grade Ⅳ, 1 case of gradeⅤ. Of 18 cases undergoing surgery, postoperative pancreatic fistula occurred in 6 cases, 2 cases of pancreatic pseudocyst, intra-abdominal abscess in 3 cases; 18 cases were cured, with 2 death cases.[Conclusion]The clinicians should maintain a high degree of vigilance on patients with blunt abdominal trauma, and consider the possibility of pancreatic injury. The early diagnosis of pancreatic injury mainly relies on history of trauma, CT examination and peritoneal fluid amylase puncture examination. The surgery which is based on MST pancreatic injury grading standards and patient＇s general condition can significantly improve the survival rate of patients.