儿童严重胰腺闭合性损伤的诊治探讨

Management of severe pancreatic blunt injury in children.

目的探讨按照美国创伤外科协会（AAST）胰腺创伤分级为Ⅲ～Ⅳ级的儿童闭合性胰腺损伤的最佳治疗方案。方法回顾性分析2008年9月至2012年10月我们收治的12例Ⅲ～Ⅳ级闭合性胰腺损伤患儿临床资料，对其治疗方法进行分析，比较不同方法的临床疗效。结果12例患儿中，2例子保守治疗，5例行开腹外引流手术，5例行ERCP诊断及胰管支架置人，随访3～51个月，均预后良好，无死亡及胰腺内外分泌不足的表现。手术组及ERCP组治疗后血淀粉酶下降及恢复经口喂养时间无明显差异，但优于保守治疗组。2例保守治疗患儿伴〉8cm的胰腺假性囊肿，于半年后自行吸收。2例外引流无效者经ERCP治疗成功，ERCP在血流动力学稳定伴主胰管破裂患儿中应用安全，显著缩短了病程。结论儿童Ⅲ-Ⅳ级胰腺闭合性损伤患儿可以不行胰腺切除术或胰腺胃肠吻合术获痊愈，部分可保守治疗痊愈。当保守治疗或外引流术不能控制病情时，ERCP可作为首选。远期预后需大量样本进一步随访。

Objetive To investigate the optimal management for severe pancreatic blunt injury （AAST III and IV） in children. Methods We analyzed the cases of blunt pancreatic injury（ AAST IIIand IV） retro- spectively. Clinical data were collected. Twelve Patients were divided into three groups （2 expectant treatment, 5 external drainage and 5 ERCP）. Length of hospital stay, improvement to clinical symptoms, and duration for hemodiastase decreased to normal, feeding by mouth after treatment, complications were used to evaluate opti- mal management for these patients. Results All tile Patients were survived heahhily and no need for resection of pancreas or internal drainage. They were followed up 3 -51 month. There is no difference in duration for he- modiastase decreased to normal, feeding by mouth after treatment between external drainage and ERCP group, but better than expectant treatment group. Two patients with expectant treatment complicated pseudocyst larger than 8cm which were disappeared spontaneously after 6 months. Two cases experienced external drainage whose symptoms could not released and finally cured by ERCP successfully. When tile haemodynamics of patients is stable, it is safety for ERCP. Conclusion Most of severe pancreatic blunt injury （AAST IIIand lV ） in chil- dren could treat with no operative, external drainage or ERCP and cured finally. We should make an independ- ent ootimal plan for different oatients. Large sample cases were needed to evaluate more exactly.