闭合性胰腺损伤诊断及外科治疗附15例报告

Diagnosis and treatment of closed pancreatic injury:a report of 15 cases

目的：探讨闭合性胰腺损伤的早期诊断和合理的外科治疗方法。方法：回顾性分析我院及武汉协和医院急诊外科自2011-04-2013-04期间共收治的15例闭合性胰腺外伤患者的临床资料。结果：6例Ⅲ级胰腺损伤患者中,1例行远端胰腺切除术和脾切除术,1例行远端胰腺切除术和保留脾脏手术,4例用prolene（普理灵）无损伤血管缝线行胰腺修补术＋胰周引流术;7例Ⅳ级胰腺损伤患者中,1例行远端胰腺切除术和脾切除术,2例行胰尾切除术,4例行胰腺空肠Roux-en-Y吻合术;2例Ⅴ级胰腺损伤患者中,2例胰头严重毁损伤并发十二指肠损伤不得已行急诊胰十二指肠切除术。平均住院时间是15d（10~27d）,总病死率是13.3%（2/15）,其余均治愈。结论：对胰腺损伤患者,及时正确的诊断和合理的外科手术治疗是减少病死率,改善预后的重要因素。

Objective：To explore the methods of early diagnosis and surgical treatment of closed pancreatic injuries.Method：The clinical data of 15 patients with closed pancreatic injuries in our hospital from April 2011 to April 2013 were retrospectively analyzed.Result：Of the 6 gradeⅢ patients,1 underwent distal pancreatectomy with splenectomy,1 had pancreatectomy with preservation of the spleen,with the remaining 4 individuals undergoing drainage respectively.Of the 7 grade Ⅳ patients,1 underwent distal pancreatectomy with splenectomy,2 underwent distal pancreatectomy and 4 underwent Roux-en-Y pancreaticojejunostomy.Of the 2 grade V patients,Emergent pancreaticoduodenectomy（EPD）was performed for the two patients because of the severity of the associated injuries and duodenum injury.Mean hospital length of stay was 15 days（range,10~27 days）.Overall mortality rate was 13.3%（2 of 15 cases）,the other were cured.Conclusion：Correct and timely diagnosis and surgical treatment are the principal determinant of decreasing mortality in cases of pancreatic trauma.