胰腺损伤48例诊治分析

Diagnosis and treatment of 48 cases of pancreatic trauma

目的探讨胰腺损伤的诊治方法及保护胰腺内分泌功能的重要性。方法回顾性分析2002年~2010年我院收治的48例胰腺损伤的临床资料。I级损伤保守治疗7例。I、II级损伤31例病人予以清创引流。III级损伤3例行近端缝扎,远端胰腺空肠Roux-Y吻合。1例行近端缝扎,远端胰腺切除。2例行近端缝扎,远端止血引流。IV级损伤：1例行两断端与空肠行Roux-Y吻合;2例行近端缝扎,远断端止血引流。V级损伤1例行手术探查。结果全组47例治愈,两次手术3例,胰漏5例,死亡1例,均随访2年,患者血糖水平正常。结论早期手术并实行损伤控制性外科原则是提高胰腺损伤治疗效果的关键。保证生命安全的前提下,需要对其内分泌功能的保护予以更多的关注。

【Objective】To explore the diagnosis and treatment of pancreatic trauma, and the importance of pro- tection of pancreatic endocrine function. 【Methods】48 pancreatic trauma patients admitted to our hospital from 2002 to 2010 were retrospectivelyanalyzed. 7 cases on level Iof injury were cured by conservative treatment. 31 cases onlevel I ~II received thorough debridement and adequate drainage. In level IIIof injury, 3 cases received proximal ligation of pancreas, and Roux-en-Y end-to-end distal pancreaticojejunal. 1 case received the proximal suture, and distal pancreatic resection. 2 cases were done the proximal suture, distal hemostasis drainage. In in- juryIV： 1 case was done with Roux-en-Y of end-to-end pancreaticojejunal. 2 cases were done the proximal suture, and distal hemostasis drainage.【Results】47 cases were cured in our group, 3 cases received the operation twice, 5 case of pancreatic leakage, 1 case of death. All patients were followed-up of 2 years, and the blood glucose was in normal level. 【Conclusions】The keys to improve the efficacy of treatment in pancreatic trauma include earlier surgical operation, and the application of damage control surgery. More Attention to the protection of endocrine function should be paid.