胰腺损伤的外科治疗(附48例报告)

Surgical treatment of pancreatic trauma:A report of 48 cases

目的探讨胰腺损伤治疗经验。方法回顾性分析自2002年4月至2014年10月中国医科大学附属第一医院普通外科收治的48例胰腺损伤病人的临床资料,按美国创伤外科学会(AAST)对胰腺损伤分级,结合影像学资料及术中所见将全部病例分级为:Ⅰ级17例,Ⅱ级16例,Ⅲ级9例,Ⅳ级5例,Ⅴ级1例。7例行非手术治疗。41例行手术治疗:胰腺清创冲洗引流术10例;胰腺破裂修补引流术16例;于外院行脾切除术,后入中国医科大学附属第一医院行胰体胰尾切除术1例;胰体尾切除术5例;保留脾脏胰体尾切除术1例;近端断裂胰腺缝闭,远端胰腺-空肠Roux-en-Y吻合术6例;胰十二指肠切除术1例;一期近端胰腺缝闭、远端胰管外引流术,二期胰腺瘘管-空肠或胃吻合术1例。结果 44例治愈,其中13例出现单种或多种术后并发症。4例因多发创伤死于多器官功能障碍。结论正确掌握手术时机,合理选择手术方式以及完善的支持治疗是成功治疗胰腺损伤的关键。

Objective To discuss the experience of treatment of pancreatic trauma.MethodsThe clinical data of 48 cases of pancreatic trauma treated surgically from April 2002 to October 2014 in Department of General Surgery, theFirst Hospital of China Medical University were analyzed. According to American Association for the Surgery ofTrauma-Organ Injury Scale and the statuses in the results shown by imageological examinations and the operations,17 cases were in gradeⅠ,16 in grade Ⅱ,9 in grade Ⅲ,5 in grade Ⅳ,and 1 in grade Ⅴ. Seven cases received non-surgerytreatments. Forty-one cases underwent surgeries including the debridement and drainage of the scathing pancreas in 10 cases,neoplasty and drainage of the cracked pancreas in 16 cases,the body and tail of pancreas resection aftersplenectomy in local hospital in 1 case,distal pancreatectomy in 5 cases,distal pancreatectomy with spleen reservationin 1 case, ligation of proximal pancreas with Roux-en-Y distal pancreaticojejunostomy in 6 cases,pancreatoduodenectomy in 1 case,anastomosis of fistula with jejunum or stomach in the second-stage after the ligation ofproximal pancreas with distal pancreatic duct drainage in the first-stage in 1 case.ResultsForty-four cases recoveredfully in which thirteen cases suffered postoperative complications. Four of all died of MODS due to multiple trauma.ConclusionThey are keys to cure the patients of pancreatic trauma successfully that appropriate timing, plan of theoperation and thorough supportive treatment.