胰腺损伤28例救治体会

Management of pancreatic injury:experience in 28 cases

目的探讨胰腺损伤的诊断和救治策略。方法回顾性分析我科2000年1月～2009年6月收治胰腺损伤28例的临床资料。胰腺脏器损伤分级(OIS):Ⅰ级13例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例,Ⅴ级1例。全组均有合并伤,休克15例(53.6%)。均手术治疗,单纯引流14例,清创修补+引流9例,胰尾切除1例,胰体尾切除2例,胰头颈关闭+远端胰空肠Roux-en-Y吻合术1例。并发症8例(28.6%),胰瘘及胰腺脓肿各2例,上消化道出血及胰腺假性囊肿各1例,创伤性胰腺炎2例。结果治愈25例(89.3%),死亡3例,死因为失血性休克、腹膜感染和多器官功能障碍综合征(MODS)。结论选择合理术式能提高救治成功率;对Ⅲ级胰腺伤采用远端胰切除,以及充分可靠引流是减少术后并发症的关键。

Objective To explore the clinical diagnosis and surgical treatment of pancreatic injury.Methods The clinical data of 28 cases of pancreatic injury in our unit from Jan.2000 to Jun.2009 were studied retrospectively.According to the American Association for the Surgery of Trauma-Organ Injury Scaling（AAST-OIS）,there were 13 cases of pancreatic injury in grade Ⅰ,10 in grade Ⅱ,3 in grade Ⅲ,1 in grade Ⅳand 1 in gradeⅤ.All cases received operative treatment.The type of surgical procedure for pancreatic injury included simple drainage in 14 cases,debridement or repair plus drainage in 9,distal pancreatectomy in 1,body and distal pancreatectomy in 2,proximal pancreatic close plus distal Roux-en-Y pancreaticojejunostomy in 1,damage control of surgery（DCS）in 1.Postoperative complication occurred in 8 cases（28.6%）including pancreatic fistula in 2 cases,pancreatic Abscess in 2,upper gastrointestinal bleeding in 1,pancreatic pseudocyst in 1,and traumatic pancreatitis in 2.Results Twenty-five cases（89.3%）cured.Three died of hemorrhagic shock,peritoneal infection and MODS respectively.Conclusion The pancreatic injury should be considered in treating upper abdominal injury,especially steering wheel injury.A proper surgical procedure can increase the success rate;distal pancreatectomy in grade Ⅲ and reliable drainage is the key to reduce the postoperative complication.