胰腺创伤的早期诊断及治疗

Diagnosis and treatment of pancreatic in an early stage

目的 阐述胰腺创伤的早期诊断及治疗方法。方法 回顾性总结 1988年元月～ 2 0 0 1年 11月 2 6例胰腺创伤的临床资料。结果 全组术前确诊率 5 0 % ,2 5例治愈 ,1例死亡。并发胰瘘 6例 ,外伤性胰腺炎 2例 ,胰周脓肿 1例 ,假性囊肿 1例 ,并发症为 4 0 %。结论 详尽的现病史及仔细的腹部体检 ,诊断性腹腔穿刺及灌洗 ,血清、尿淀粉酶测定及CT检查 ,有助于早期诊断。MRCP对判断有无主胰主管损伤极有临床价值。不必过分强调明确诊断 ,据剖腹探查指征尽早剖腹探查 ,按胰腺创伤分类 ,选用个体化治疗方案。早期诊断、适宜的药物 ,恰当的术式及通畅引流是提高治愈率 ,减少并发症 ,降低死亡率的关键 ,Uli nastatin在胰腺创伤应用中有肯定价值。保留脾脏的脂体尾切除 ,避免了无辜性脾切除 ,操作并不复杂 。

AIM Briefly introduce thg early diagnosi and treatment of pancrectic trauma. METHOD Retrospective analyses on the clinical data of patients with pancreatic trauma between January 1988 to Febuary 2001. RESULTS The diagnostic accuracy before operation was 65%,19 cases were cured, 1 casedied,4 cases developed complication of pancreatic fistula,2 cases were with traumatic pancreatitis,one case with peripancreaticabscess, one case with pseudocyst. All the complication reached a ratio of 40%. CONCLUSION The early diagnosis of pancreatic trauma was difficult, but it still had some national laws for us to follow. Detailed present history,abdominal physical examination,trans abdominal needle aspiration and washing , blood urine, urinary amylase and CT scan all can be of diagnostic usefulness.MRCP is a critical clinical use for cheeking whether the main pancreatic duct is traumatized. It is not necessary to emphasize the clearest diagnosis.The open abdominal inspection should be applied if it was indicated. The treatment should be individualized according to the types of pancreatic traumas.The early diagnosis,appropriate medication and surgery, and surgery,and outpouring fluid drainage were critical for treatment , less complication, and lower death. Ulinastation was sure in the theapeutics of the pancreatic trauma.It should be advocated to apply the simple technique, ie. the pancreatic tail removal, and the retain of the spleen.