闭合性胰腺损伤53例的诊断与治疗

Diagnosis and treatment of 53 patients with closed pancreatic trauma

目的探讨闭合性胰腺损伤的临床诊疗经验。方法彬县县医院外科53例闭合性胰腺损伤患者术前均进行CT检查及B超检查后进行手术治疗,根据美国创伤外科协会(AAST)提出的胰腺损伤分级,Ⅰ级5例,Ⅱ级20例,Ⅲ级21例,Ⅳ级5例,Ⅴ级2例。其中行穿刺引流术11例,剖腹探查单纯引流术22例,损伤远端胰腺切除14例,胰腺肠吻合术4例,胰十二指肠切除术2例。结果该组患者治愈49例,4例死亡,其中1例死于严重并发症,1例死于术后腹腔大出血,2例死于败血症。结论胰腺损伤充分检查、及时适当外科治疗是救治成功的关键。

Objective To investigate the clinical experience in diagnosis and treatment of closed pancreatic trauma.Methods 53 patients with closed pancreatic trauma in county hospital of Binxian county were treated surgically after preoperative CT examination and B-type ultrasonic inspection.According to the classification of pancreatic trauma proposed by American Association for the Surgery of Trauma（AAST）,5 cases in 53 patients were gradeⅠ,20 cases were grade Ⅱ,21 cases were grade Ⅲ,5 cases were grade IV and 2 cases were gradeⅤ.Among the 53 cases,11 cases were with puncture drainage,22 cases with laparotomy simple drainage,14 cases with distal pancreatectomy of trauma,4 cases with pancreatic and intestinal anastomosis and the other 2 cases with pancreatoduodenectomy.Results 49 cases in the 53 patients with closed pancreatic trauma were cured,and the other 4 cases died,in which 1 case died of severe complication,1 case died of postoperative intraperitoneal massive bleeding and the other 2 cases died of sepsis.Conclusion The key of successful treatment of pancreatic trauma is full inspection and appropriate surgical treatment timely.