钝性胰腺损伤36例诊治分析

Management of blunt pancreatic injury: experience in 36 cases

目的探讨钝性胰腺损伤的诊断和救治方法。方法回顾性分析我科2007年1月～2012年10月收治钝性胰腺损伤36例的临床资料。胰腺脏器损伤分级(OIS):Ⅰ级15例,Ⅱ级10例,Ⅲ级6例,Ⅳ级4例,Ⅴ级1例。33例有合并伤,休克21例(58.3%)。均手术治疗,单纯引流15例,清创修补+引流9例,胰尾切除1例,胰体尾切除5例,手术引流+填塞1例,经皮穿刺置管引流1例,胰头颈清创+胆管、十二指肠、胰周等多处引流术1例。并发症14例(38.9%),胰瘘4例,胰腺假性囊肿3例,胰腺脓肿2例,出血2例,创伤性胰腺炎3例。结果治愈34例(94.4%),死亡2例,死因分别为失血性休克和腹腔感染。结论胰腺损伤手术探查的关键是明确主胰管有无损伤;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 the diagnosis and treatment for blunt pancreatic injury .Methods The clinical data of 36 cases of blunt pancreatic injury in our unit from Jan .2007 to Oct.2012 were studied retrospective-ly.According to the American Association for the Surgery of Trauma-Organ Injury Scaling （ AAST-OIS） ,there were 15 cases of grade I pancreatic injury ,10 cases of grade Ⅱ,6 cases of grade Ⅲ,4 cases of grade Ⅳ and 1 case of grade Ⅴ.Of them,33 cases（91.6%） had associated injuries,and 21 cases had shock （58.3%）.All cases un-derwent surgical treatment .The surgical maneuver included simple drainage in 15 cases,debridement or repair plus drainage in 9,distal pancreatectomy in 1,body and distal pancreatectomy in 3,proximal pancreatic close plus distal Roux-en-Y pancreaticojejunostomy in 1.Postoperative complications occurred in 12 cases（33.3%）,including pan-creatic fistula in 4 cases,pancreatic pseudocyst in 3,pancreatic abscess in 2,and traumatic pancreatitis in 2.Re-sults Thirty-four cases（89.3%） were cured.Two patients died of hemorrhagic shock and peritoneal infection re-spectively .Conclusion The key of surgical treatment for pancreatic injury is to identify whether the main pancre-atic duct is injured .Surgical maneuver should be selected based on the classification of pancreatic injury ,and it can decrease the morbidity and mortality obviously in the patients with blunt pancreatic injury .