闭合性胰腺损伤的诊断和治疗

Diagnosis and treatment of blunt pancreatic trauma

目的探讨闭合性胰腺损伤的治疗。方法分析我院近5年来收治的81例确诊为胰腺损伤患者的临床资料。结果术前B超检查阳性率为44.00%,CT检查阳性率为47.66%,腹腔穿刺液淀粉酶（Ams）升高占57.35%,血Ams升高占59.49%,尿Ams升高占53.6%。保守治疗17例,手术治疗64例,死亡9例,病死率为11.11%。结论腹部闭合性损伤中胰腺损伤术前诊断较困难,外科医生要提高对胰腺损伤的警惕性,综合多种检查,及早明确诊断。视胰腺损伤的程度及合并伤选择合理的治疗方式、手术术式,对循环稳定的Ⅰ、Ⅱ级单纯胰腺损伤患者可行保守治疗,有合并伤者及Ⅲ-Ⅴ级胰腺损伤者则宜行手术治疗。

Objective To investigate the diagnoses and treatment of blunt pancreatic trauma.MethodsThe clinical data of 81 patients with blunt pancreatic trauma were analyzed retrospectively.ResultsThe positive diagnosis rate was 44.0% for BUS examination,but 44.76% for CT scanning.The Amylases in the abdominal fluid,blood,urine were examined,with positive rate of 57.35%,59.49% and 53.16%,respectively.17 patients received conservative treatment,while 64 patients received surgical treatment,with total mortality of 11.11%（9/81）.ConclusionIt is difficult to diagnose of blunt pancreatic trauma.It is important to alert the pancreatic trauma for the surgeons and all examines should be taken into consideration.