72例胰腺损伤诊治分析

Analysis of dignosis and treatment of 72 cases with pancreatic injures

目的探讨胰腺损伤的诊断和治疗方法。方法对近10年间该院手术治疗的胰腺损伤72例作回顾性分析。主要诊断技术为CT,MRI,内镜逆行胰胆管造影(ERCP)等;手术方法包括修补加引流术、远端胰腺切除术、空肠与远端胰腺Roux-en-Y吻合术、胰十二指肠修补术加广泛引流、胰十二指肠修补术加憩室化术和"损伤控制外科(DCS)"术等术式。结果 52例腹内脏器合并伤中,穿透伤13例(25%),钝性伤39例(75%),二者比较差异无统计学意义(χ2=0.000,P>0.05);49例腹以外部位合并伤中,穿透伤6例(12.24%),钝性伤43例(87.76%),二者比较差异有统计学意义(χ2=13.310,P<0.01)。72例患者中死亡9例(12.5%),合并伤、失血总量、伤后至手术时间等因素与患者死亡具有相关性(P<0.05)。术后并发症共18例(25%),Ⅰ～Ⅱ级伤3例,Ⅲ～Ⅴ级伤15例,二者比较差异有统计学意义(χ2=10.667,P<0.01)。术后并发症包括出血、胰瘘、胰腺假性囊肿、胰腺脓肿、创伤性胰腺炎、胰腺内外分泌功能障碍等。72例患者中存活63例。34例胰腺损伤级别为Ⅲ～Ⅴ级的患者,伤后随访6个月至22年(中位数随访时间2年),情况良好。结论避免胰腺损伤早期漏诊,手术时迅速控制合并伤大出血,按胰腺损伤分级采用不同术式,可明显减少并发症和病死率。

Objective To explore diagnostic and therapeutic modalities of pancreatic trauma. Methods The dates of 72 patients with pancreatic injuries treated operatively during the past 10 years in chongqing emergency medical center（CEMC） were studied retrospectively. The diagnostic methods were mainly CT, MRI, and ERCP etc. Various surgical procedures included simple suture or drainage,distal pancreatectomy, distal pancreaticojejunostomy, pancreaticoduodenal repair plus a diverticularization and multiple drainage,Whipple＇s procedure,and damage control surgery（DCS） ,etc. Results 52 patients had associated injuries of other viscera in the abdomen of them 13 （25% ） were penetrating injury, and 39 （75%） blunt （ 2 ： 0. 000, P〉 0.05 ）. 49 patients sustained simul- taneity extra-abdominal injuries^of them 6（12.24%） were penetrating,and 43（87.76%） blunt（χ^2 =13. 310,P〈0.01）. The overall mortality rate was 12.5% （9/72）. Relatively lethal factors were associated injuries, the amount of blood loss, and preoperative time, etc. Postoperative morbidity was 25% （ 18/72） including bleeding, pancreatic fistula, pancreatic pseudoeyst, pancreatic abscess, trau- matic pancreatitis, and disfunction o{ internal and external secretion of the pancreas, etc. There was a significant difference of the in cidence of postoperative complication between grade Ⅲ- Ⅴ （15/18） and grade Ⅰ -- Ⅱ （3/18,χ^2 =10. 667,P〈0.01）. Of 63 survi- vors,34 with pancreatic injury of grade Ⅲ --Ⅴ were followed up from 6 months to 22 years（medium was 2 years） ,the patients＇ conditions were well. Conclusion To decrease obviously the morbidity and mortality in the patients with pancreatic injuries, it is critical that initially missed diagnosis of pancreatic injuries is avoided,massive hemorrhage from associated injuries is ceased expedi- tiously during the operation, and a corresponding surgical procedure is selected exactly based on the classification of pancreatic inju- ry.