胰腺外伤术后严重并发症八例诊治体会

Reflection on Diagnosis and Therapy of 8 Cases of Severe Complications of Traumatic Pancreatitis

目的探讨胰腺外伤术后严重并发症的诊断及治疗方法。方法回顾性分析我科2009年3月—2012年12月收治的由外院转入的胰腺外伤术后严重并发症8例的临床资料。结果本组均合并胰漏、严重腹腔感染,合并腹部切口裂开4例,合并腹腔大出血3例,合并胃、十二指肠及胆总管瘘,高位小肠瘘各1例。入院后主要的治疗措施包括急诊行剖腹探查止血、胰体尾加脾切除术1例,胃造瘘加空肠营养管置入术1例,数字减影血管造影下肝左动脉加脾动脉栓塞2例,经侧腹壁小切口腹膜后脓肿清创引流术2例,腹腔双套管引流5例。本组经治疗12-79 d均获痊愈,无一例死亡,其中1例并发结肠瘘,经局部加强换药后愈合。结论针对复杂胰腺外伤术后并发症的治疗,应准确评估病情,选择合适手术干预时机,尽可能采取微创引流等方式;保持腹腔引流通畅;高度重视肠内营养,维护机体自身调节功能和免疫力;严格控制抗感染药物的应用。灵活运用上述原则是治疗成功的保证。

Objective To summarize the clinical experiences of diagnosis and treatment of severe postoperative complications of traumatic pancreatitis. Methods Between March 2009 and December 2012,8 patients with pancreatic injury undergoing operations in other hospitals were referred to our hospital because of severe complications such as severe celiac infection,bleeding,and pancreatic fistula,intestinal fistula,etc. The clinical data were retrospectively analyzed. Results 8cases were complicated with pancreatic fistula and abdomen severe infection,4 cases with abdomen wound disruption,3 cases with peritoneal cavity hemorrhea,1 case with gastric fistula,duodenal fistula,and common bile duct fistula,1 case with high position-enteric fistula. The type of intervention procedures of 8 patients were as follows： 1 case of laparotomy,splenectomy and resection of pancreatic body and tail,1 case of gastrostomy and placement of jejunum nutrition tube,2 cases of DSA guided left hepatic artery and splenic artery embolism,2 cases of bilateral retroperitoneal abscess debridement and drainage,5cases of replacement of double-cannula drainage with continuous suction. All the patients were cured with no mortality. The hospital stay was 12-79 days. Colonic fistula occurred in 1 patient and healed naturally. Conclusion The key points of successful treatment include accurate assessment of the patient＇s condition,appropriate surgical intervention as soon and as miniinvasive as possible,emphasis on enteral nutrition and maintenance of host immunity,unobstructed intraperitoneal drainage and minimal use of anti-infection drugs.