闭合性胰腺损伤的诊断和手术治疗分析

Diagnosis and surgical treatment of blunt pancreatic injury

目的探讨闭合性胰腺损伤的诊断和手术治疗体会。方法回顾性分析我科收治的闭合性胰腺损伤36例临床资料。结果本组病例超声确诊11例,CT确诊23例,腹腔穿刺确诊20例。本组病例均行手术治疗,胰漏6例,腹腔出血2例,胆漏1例,腹腔感染2例。全组死亡4例,死亡原因主要为多器官功能衰竭。结论胰腺损伤的诊断首选B超、CT检查。根据胰腺损伤的程度,选择合理的手术方式,有效的手术方案和术后通畅的引流可提高治愈率,降低病死率。主胰管损伤的识别和定位是治疗成功的关键。

Objective To explore the experience of diagnosis and surgical of blunt pancreatic injury.Methods The clinical data of 36 cases with blunt pancreatic injury who received surgical therapy in our hospital from Janurery 2000 to December were retrospectively analyzed.Results The conformity diagnosis rate of ultrasound appearances（US） was 30.56%（11/36）,CT was 63.89%（23/36）,abdominal puncture was 55.56%（20/36）.All 36 cases with blunt pancreatic injury underwent operation,and post-operative complications which include 6 cases of pancreatic fistula,2 cases of intraperitoneal hemorrhage,1 cases bile leakage and 2 cases intraperitoneal infection.Four patients died of multiple organ failure.Conclusion US and CT was first selection in the diagnosis of blunt pancreatic injury.Different operative procedures should be chosen according to the severity of pancreatic trauma,the thorough and effective surgical procedure and postoperative wide drainage routes are critical to increase the crue rate and decrease mortality rate.Identification and location of main pancreatic duct disruption are also important determinants in the appropriate management of blunt pancreatic injury.