胰腺外伤30例的诊断与个体化治疗体会

Diagnosis of 30 Cases with Pancreatic Trauma and Experience of Individual Treatment

目的探讨胰腺外伤的诊断及个体化治疗方法。方法回顾分析大庆油田总医院及大庆市第四医院2006年1月—2010年12月急诊收治的30例胰腺外伤患者,均有明确外伤史,且均有腹膜炎表现,均给予急诊手术,术中优先处理危及患者生命的其他脏器、血管损伤,生命指征平稳后再处理胰腺外伤。结果无并发症治愈20例;发生肠瘘4例,保守治疗后治愈;发生假性胰腺囊肿3例,于术后半年至1年行二次手术后治愈;发生术后消化道应激性溃疡出血2例,保守治疗后治愈;死亡1例,为肝、脾联合破裂,术后死于多器官功能衰竭。结论联合应用CT、腹腔穿刺、血淀粉酶测定可提高术前胰腺损伤诊断率,术中仔细探查胰腺是防止遗漏胰腺损伤的重要措施,个体化治疗可提高胰腺损伤的治愈率。

Objective To investigate the diagnosis of pancreatic trauma and methods of individual treatment.Methods 30 pancreatic trauma patients admitted to General Hospital of Daqing Oil Field and Daqing Fourth Hospital from January 2006 to December 2010 were retrospectively analyzed.The patients all had trauma history and peritonitis manifestations,and they were all treated with emergency operation.Life threatening organs and blood vessels were treated with priority before the pancreatic trauma was treated when vital signs were stable.Results 20 cases were cured without complications;four cases had intestinal fistula,and were cured with conservative treatment;three cases had pancreatic pseudocyst,and were cured by second time operation six months to one year after the first time operation;two cases had gastrointestinal stress ulcer bleeding and were cured by conservative treatment;one case with liver and spleen rupture died due to multiple organ failure after operation.Conclusion Combined application of CT,abdominal puncture and blood amylase determination can improve diagnosis rate of pancreatic trauma before operation.Intraoperative exploration of pancreas is an important approach to prevent omission of pancreatic injuries.Individualized treatment can improve cure rate of pancreatic trauma.