胰腺损伤诊断和治疗分析（附43例报告）

Diagnosis and treatment analysis on 43 cases of pancreatic trauma

目的 探讨损伤性胰腺的诊断与外科治疗原则,以及保护胰腺内分泌功能的重要性.方法 回顾性分析我院2000年1月至2013年1月收治的43例损伤性胰腺病人的临床资料,总结胰腺损伤的诊断与外科治疗方法.结果 全组43例治愈,Ⅰ级损伤保守治疗7例;Ⅰ、Ⅱ级损伤21例,病人予以清创引流;Ⅲ级损伤8例：4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,3例行近端缝扎,远端止血引流;Ⅳ级损伤5例：3例行两断端与空肠Roux-Y吻合,2例行近端缝扎,远断端止血引流;Ⅴ级损伤2例：2例行手术探查.其中,两次手术5例,胰漏5例,均随访2年,患者血糖水平正常.结论 早期诊断、及时手术探查以及术中选择合理的手术方式,保证生命安全,同时,对其内分泌功能的保护予以更多的关注.

Objective To study the diagnosis and surgical treatment principle for pancreatic injury,and the importance of protecting pancreatic endocrine function.Methods 43 pancreatic trauma patients admitted to our hospital from January 2000 to January 2013 were retrospectively analyzed,to study the diagnosis and surgical method for pancreatic trauma.Results All 43 cases were cured,7 cases on level Ⅰ of injury were cured by conservative treatment.21 cases on level Ⅰ-Ⅱ received debridement and adequate drainage; 8 cases in level Ⅲ of injury,4 cases received proximal ligation of pancreas,and Roux-en-Y end-to-end distal pancreatic jejunal.1 case received the proximal suture,and distal pancreatic resection.3 cases were done the proximal suture,distal hemostasis drainage.5 cases in injury Ⅳ：3 cases was done with Roux-en-Y of end-to-end pancreatic jejunal.2 cases were done with the proximal suture,and distal hemostasis drainage.2 cases of grade Ⅴ injury：2 patients underwent operation.Among them,5 cases given with two operations,5 case of pancreatic leakage,and were followed up for 2 years,showing normal blood glucose level in patients.Conclusion 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.