胰腺损伤的诊断与外科治疗探讨

Diagnosis and surgical treatment for pancreatic injury

目的:探讨胰腺损伤的诊断与外科治疗原则。方法:回顾性分析我院2002年2月至2012年10月收治的39例胰腺损伤病人的临床资料,总结胰腺损伤的诊断与外科治疗方法。本研究胰腺损伤程度分级标准采用Lucas4型分级标准。结果:本研究病人均行手术治疗并确诊,单纯胰腺损伤11例(28.2%),合并其他脏器损伤28例(71.8%)。治愈31例,术后早期死亡3例,死于多器官合并伤;后期死亡5例,死于严重的胰腺坏死、胰漏和感染所致的多器官功能衰竭,病死率为20.5%。对Ⅳ级严重胰腺损伤的4例病人先行控制性手术,后行确定性手术,获得成功。结论:MRCP适合于胰管损伤的诊断,主胰管断裂的识别和定位也是治疗成功的关键,对Ⅳ级严重胰腺损伤病人先行控制性手术,后行确定性手术,以提高治愈率。

Objective To study the diagnosis and surgical principle for pancreatic injury. Methods The clinical data of 39 cases with pancreatic injury in our hospital from Feb 2002 to Oct 2012 were analyzed retrospectively. Lucas classification of 4 grading was used to evaluate the extent of pancreatic injuries. Results The patients with pancreatic injuries were diagnozed all by operation. Eleven cases （28.2%） were pancreatic injuries only and 28 cases （71.8%） combined with other organ injuries. Totally 31 cases were cured. The mortality （8 cases） was 20.5% of which 3 case died postoperative early with muhible organ injuries and 5 cases postoperative late by muhible organ dysfunction syndrome due to severe pancreatic necrosis, pancreatic leakage and pancreatic infection. Four cases with IV degree of pancreatic injuries were cured by damage control procedure firstly and definitive operation subsequently. Conclusions MRCP is suitable for the diagnosis of pancreatic duct injury. The identification and location of main pancreatic duct injury is the key to successful treatment. Damage control surgery should be oerformed for severe pancreatic iniury.