胰腺损伤的诊断及治疗(附29例报告)

Diagnosis and treatment of pancreatic injury:A report of 29 cases

目的探讨胰腺外伤的诊断及并发症的防治方法。方法回顾性分析29例胰腺损伤病例的临床资料。结果 CT诊断准确率达76.2%。非手术治疗5例,其中I级3例,II级2例,并发胰腺假性囊肿2例,3个月后行囊肿内引流术治愈。手术患者24例,术后死亡2例,死于多脏器功能衰竭;其余22例病人治愈出院,术后并发胰瘘及不同程度腹腔感染9例,腹腔出血2例,经治疗止血,3例并发假性胰腺囊肿2例经非手术治疗后消失,1例6个月后行囊肿空肠内引流术治愈。无腹腔脓肿。结论早期诊断,及时剖腹探查,选择合理的手术方式,有效充分腹腔引流及综合处理合并伤可提高胰腺损伤的治愈率、降低并发症和病死率。

Objective complications of pancreatic injury To explore the methods of diagnosis, treatment and prevention of Methods The Clinical data of 29 cases with pancreatic injury were analyzed retrospectively. Results The confirmed diagnosis rate of CT was 76.2%. Five cases received nonoperative treatment, including 3 cases of grade I and 2 of grade II injury. Pancreatic pseudocyst occurred in 2 patients, and were cured by cyst internal drainage after 3 months. A total of 24 cases with pancreatic injury underwent operation. Among the 24 cases, 22 patients were cured and two patients died of multiple organ failure. Pancreatic fistula associated with different degrees of abdominal infection occurred in 9 patients, 2 cases of abdominal bleeding, 3 cases of pancreatic pseudocyst. Conclusion Early diagnosis and timely exploratory laporotomy and choosing reansonable surgical procedure effective and enough abdominal drainage and combined treatment would improve the cure rate and reduce the postoperative complication and mortality for pancreatic injury.