胰腺外伤的处理经验——附45例报告

Experiences in management of pancreatic trauma(Report of 45 cases)

目的探讨胰腺损伤的处理经验。方法回顾性分析我院及佛山市第一人民医院近10年来收治的45例胰腺外伤患者的临床资料,其中对12例Ⅰ级损伤患者行保守治疗,4例Ⅰ级损伤患者行介入超声治疗;另外29例患者则选择外科手术治疗,其中行单纯手术引流6例,清创修补引流11例,胰尾或胰体尾切除术4例,右半肝联合远端胰腺加脾切除1例,近端胰腺关闭、远端胰腺行胰胃吻合2例,胰十二指肠切除4例,肝、胆总管、十二指肠、胰修补加胃及空肠造瘘1例。结果全组治愈43例,2例死与多脏器功能衰竭,胰瘘4例,12指肠瘘1例,均经保守治疗后痊愈。结论根据胰腺外伤的不同位置和程度,选择合适的处理方法有利于提高胰腺外伤的治愈率,减少并发症的发生率。

Objective To summarize experiences in management of pancreatic trauma. Methods A total 45 cases with pancreatic trauma were included in the study. The data were collected from the patients admitted in The First People＇s Hospital of Foshan from 2003 to 2013 and were analyzed retrospectively. Results Among 45 cases, 12 underwent conservative treatment, four were given ultrasound guided interventional therapy. Surgical procedure was performed in 29 cases, including simple surgical drainage in six cases, debridement and drainage in 11 cases, partial pancreatectomy in four cases, right hemihepatectomy ＋distal in one case, pancreatectomy ＋splenectomy in one case, pancreaticogastrostomy in two cases, Whipple procedure in four case, combined repairment of liver in one case, CBD, duodenum and pancreatic injury ＋ gastrostomy and jejunostomy in one case. Forty- three patients were cured, two patients died from multiple organs failure. Pancreatic fistula occurred in four cases and recovered by conservative treatment. Conclusion The individual treatment based on site and severity of pancreatic trauma is the key to improve cure rate.