胰腺损伤的诊断与治疗

DIAGNOSIS AND TREATMENT OF PANCREATIC TRAUMA

目的 进一步提高胰腺损伤的诊断和治疗水平。方法 回顾性分析近 10年收治的胰腺损伤 43例的临床资料。结果 单纯胰腺损伤仅 3例 ( 7% ) ,40例 ( 93% )为多发伤或多脏器伤 ,39例 ( 90 .7% )入院时已有明显的腹腔内大出血休克或空腔脏器穿孔的腹膜炎体征。术前确诊仅 4例 ( 9.3% ) ,术中漏诊 2例 ;术后死亡 4例 ( 9.3% ) ,非胰腺损伤死亡 3例 ,因漏诊再次手术死于多脏器功能衰竭 1例 ;胰瘘 5例中漏诊所致 2例。结论 病史和查体是诊断胰腺损伤的基础 ,剖腹探查是诊断胰腺损伤的首要可靠方法 ;早期诊断 ,避免漏诊 ,合理的术式 。

Objective To elevate the level of diagnosis and treatment for pancreatic trauma.Methods Clinical data of 43 cases with pancretic trauma in the past 10 years were analysed retrospectively.Results There were 3(7%) patients with single pancreatic trauma,40(93%) complicated with multiple trauma or multiple organ trauma,39 cases underwent the emrngent surgery for shock from abdominal bleeding or peritonitis from perforation of abdominal organs at the time of admission.Only 4 cases were preoperatively diagnosed and 2 were misdignosed in operation.4(9.3%) died after operation,3 patients died of other causes but pancreatic trauma,1 died of multiorgan failure because of the misdiagnosis in the first operation.Of 5 pancreatic fistula,2 were misdiagnosed.Conclusion History and physical examination are diagnosic basis of pancreatic trauma and exploring operation is reliable diagnosic means.To make diagnosis early,avoid misdiagnosis and take reasonable operative procedure are the key to reduce complication and mortality.