胰腺损伤术后腹腔大出血治疗分析

Diagnosis and treatment of postpancreatectomy peritoneal cavity hemorrhage in patients with grade Ⅲ to Ⅳ pancreatic injury

目的探讨Ⅲ～Ⅳ级胰腺损伤术后腹腔大出血的治疗方法及防范措施。方法40例Ⅲ～Ⅳ级胰腺损伤患者，其中21例行远端胰体尾切除和／或脾切除术，17例行胰头断端缝合＋胰体尾空肠Roux-Y式吻合术，2例行胰管吻合。结果行远端胰体尾部切除术和／或脾切除21例中，1例死于多器官功能衰竭，2例出现胰瘘；17例行胰头断端缝合＋胰体尾空肠Roux-Y式吻合术，10例发生胰肠吻合口瘘合并腹腔大出血；2例行胰管吻合者，术后均出现胰瘘及腹腔大出血；经再次开腹手术、三球压迫法止血及切除胰尾体，10例抢救成功，2例术中死亡；随访35例，无并发糖尿病及明显消化功能障碍者。结论远端胰腺和／或脾脏切除术可减少Ⅲ～Ⅳ级胰腺损伤术后腹腔大出血的发生，三球压迫止血法治疗胰腺损伤术后腹腔大出血安全、有效。

Objective To explore the treatment and prevention of postpancreatectomy peritoneal cavity hemorrhage in patients with grade II to IV pancreatic injury. Methods In 40 patients with grade III to IV pancreatic injury, 21 patients were performed distal pancreatectomy and/or splenectomy, 17 were performed Roux-Y pancreato-jejunostomy, and 2 were performed pancreatic duct anastomosis. Results In 21 patients undergoing distal pancreatectomy and/or splenectomy, I patient died of multiple organ failure, and pancreatic fistula occurred in 2 patients. In 17 undergoing Roux-Y pancreato-jejunostomy, 10 patients had anastomosis fistula complicated with peritoneal cavity hemorrhage. Two patients underwent pancreatic duct anastomosis and both of them had pancreatic fistula complicated with peritoneal cavity hemorrhage. Twelve patients with peritoneal cavity hemorrhage received laparotomy, tri-tampons compression hemostasis, and resection of pancreatic body and tail, in which 10 patients survived and 2 died. No diabetese mellitus or digestive dysfunction was found in the follow-up survey in 35 patients. Conclusions Distal pancreatectomy and/or splenectomy can reduce the incidence of postpancreatectomy peritoneal cavity hemorrhage in patients with grade III to IV pancreatic injury. Tri-tampons compression hemostasis is effective and safe to treat peritoneal cavity hemorrhage.