闭合性胰腺损伤延误手术分析

DILEMMAS IN THE DIAGNOSIS AND OPERATION FOR BLUNT PANCREATIC TRAUMA

目的 分析闭合性胰腺损伤延误手术的原因。方法 回顾性分析了安徽医科大学附属医院近十年来闭合性胰腺损伤延误手术治疗 9例患者的诊治过程。结果 胰腺闭合性损伤延误手术占胰腺闭合性损伤手术 6 4% (9/ 14)临床上均有不同程度上腹疼痛、呕吐、腹膜刺激征 ,伴休克 2例。术前血淀粉酶检查 6例 ,5例阳性 ;尿淀粉酶 4例 ,2例阳性 ,腹水淀粉酶检查 3例 ,均为阳性。腹穿 8例均阳性。 B超检查共 6例 ,确诊 3例。 CT检查 2例 ,确诊 1例。并发症发生率 80 % (7/ 9)。死亡 1例。结论 早期诊断闭合性腺损伤主要依靠临床表现、诊断性腹腔穿刺、淀粉酶检查和腹部及 CT检查。各种辅助检查有一定的局限性 ,术前对胰腺损伤程度认识不足 ,导致延误手术治疗 ,潜在地增加了手术的并发症和死亡率。 MRCP检查可望成为术前胰腺损伤程度判断的有效方法。

Objective To explore the reasons of delayed operation for blunt pancreatic trauma.Metheds Retrospective review the diagnosis and treatment of nine patients with blunt pancreatic trauma who admitted to The First Affiliated Hospital of Anhui Medical University.Results The operation was delayed in 9 patients with blunt pancreatic trauma(64%).The upper abdominal pain was complained in all cases accompanied by nausea,vomiting and slightly or obviously peritoneal irritation.2 of 9 cases were accompanied by shock.5 of 6 cases had high level of serum amylase.2 of 4 cases had high level of urinary amylase.Peritoneal fluid was present in 8 patients.Seven cases had complications and one died.Conclusions Early identification of blunt pancreatic trauma relies on clinic symptoms,signs,diagnostic peritoneal puncture,pancreatic amylase,B-us and CT.The results showed that limitations in each preoperative accessory examination may results in operative delays and potentially increased complications and mortality.Magnetic resonance cholangiopancreatography(MRCP)may helpful for the diagnosis.