胰十二指肠合并伤的外科治疗体会

SURGICAL TREATMENT OF COMBINED PANCREATODUODENA INJURIES

目的探讨胰十二指肠外伤后手术方式的选择和手术效果。方法对１９８８～１９９８年１０年间手术治疗的８例胰十二指肠合并伤病人的临床资料进行了回顾性分析。结果①１０年间收治胰腺外伤３２例，其中胰十二指肠合并伤８例（２６％）；②术前均未明确诊断，术中１例漏诊；③在十二指肠损伤修补的基础上，行胰腺清创６例，胰腺次全切除１例，胰尾加脾切除１例，其中５例行十二指肠憩室化术。④术后胰瘘４例，十二指肠瘘２例，腹腔感染３例。治愈６例（７５％），死亡２例（２５％）。结论胰十二指肠损伤术前诊断困难，术中探查仍有漏诊，术后并发症和死亡率高，明确损伤的程度和部位，选择合理的手术方式是提高治愈率降低死亡率的关键。

Objective To study the choice of surgical managements and the result of operation effec after pancreatoduodenal injuries. Methods Retrospective analysis was undertaken to study the surgical treatment of 8 patients with pancreatoduodenal injuies in our department during 19881998. Result 32 cases with traumatic pancreatic injuries were admitted our department during 19881998.There were 8 cases with combined panceatoduodenal injuries among these patients(26%).The definite diagnosis of these 8 cases be established before operation.Discharge diagnosis occurred in 1 case(12.5%) during exploratory lapaotomy.based on duodenal injuries,pancreatic debridement were operated in 6 cases,partial pancreectomy in 1 case, caudak pancreaticosplenic excision in 1 case and duodenal diverticulization in 6 cases. Pancreatic fistulas occurred in 4 cases, duodenal fistulas in 2 cases and intraabdominal abscess in 3 cases after operation.6 cases(75%) were cured;2 cases (25%) died. Conclusion Right diagnosis of preoperational injuries was very difficulty,the complication and mortality rate after operations were relatively high.Finding out the position and the degree of injunies to select a rensonable surical treatment is the Rey step to improve the rate of recovery and to reduce the complication.