胰腺颈部断裂伤手术指征及术式选择

Indication of surgery and operation manner selection after rupture of pancreatic neck

治疗胰颈部断裂伤可早期通过内镜放置胰管支架引流,若出现腹痛加重应手术治疗;若术前循环系统不稳,遵循损伤控制外科理念,填塞、暂时关闭腹腔后二期手术;若合并胰体尾严重挫伤,行胰体尾切除及断端修补术;若十二指肠完好,行保留十二指肠胰头切除术;若十二指肠有损伤,行十二指肠修补、远端胰腺空肠吻合、胰管结扎、断面褥式缝合术;若胰头十二指肠严重受损,同样遵循损伤控制原则。术后并发症包括出血、胰瘘、假性囊肿,预防关键在于彻底止血、充分引流;若假性囊肿直径〈5 cm可保守治疗,若急剧增大可选择超声或CT引导下置管引流或囊肿形成6~8周后手术治疗。

To treat the rupture of pancreatic neck,surgeons could first place pancreatic ductal stent through endoscopy.Surgery is indicated if the abdominal pain aggravates. Damage control surgery should be implemented if the circulation is unstable,including tamponading,closing abdominal cavity temporarily and reoperaing later on. Distal pancreatectomy and stump blanket suture will be done when distal pancreas is severely injured; Beger operation is considered when duodenum is intact, if not, surgeons should choose pancreaticojejunostomy,pancreatic duct ligation and stumpblanket suture. Damage control principle is also applied if the pancreatic and duodenum is severely injured. Complication include bleeding, fistula and psedocyst formation. Key to the prevention is stopping bleeding thoroughly and draining appropriately. When pseudocyst is less then 5cm, conservative treatment is better, if it enlarges surgeons should implement ultrasound or CT guided drainage or do the surgery 6 or 8weeks later.