胰腺损伤的诊断与治疗—附33例临床分析

The experience in diagnose and treatment of pancreatic trauma with a report of 33 cases

目的总结胰腺损伤的诊断、手术方式、并发症诊治体会。方法对我院1997年至2013年间收治的33例胰腺损伤的患者临床资料进行回顾性分析。结果 33例患者共治愈26例(79%),死亡7例(21%)。21例行手术治疗,术后9例胰瘘,1例小肠瘘,2例腹腔出血,1例多器官功能衰竭,1例消化道出血。术中死亡2例,为腹腔开放性损伤合并下腔静脉破裂大出血无法止血;术后死亡5例:2例死于脓毒血症,2例死于腹腔出血,1例死于多器官功能衰竭。I^II级胰腺损伤患者有1例死亡,Ⅲ~V级胰腺损伤有6例死亡的。结论胰腺损伤并发症高,处理棘手,伴有胰管损伤者死亡率高,早期诊断、有效的手术探查及方法是胰腺损伤治疗的关键。

Objective To summarize the experice of the diagnosis and treatment of pancreatic trauma.Methods The clinical data of 33 patients with pancreatic trauma treated in our hospital from1997 to 2013 were collected for retrospective analysis.Results Among 33 cases,26 cases were cured（79%）and 7 dead（21%）.Twenty-one cases were treated with surgical operation,in whom the postoperative complications included nine cases of fistula of duodenum,one enteric fistula,two intra-abdominal hemorrhage,.one multiple organ failure and one gastrointestinal bleeding.Two cases were dead during the operation because of hemorrhage caused by abdominal open wound with inferior vena cava injury..Five case were dead postoperatively,.two with sepsis,.two with intra-abdominal hemorrhage and one with multiple organ failure.Of patients with grade I -II of pancreatic trauma,one case was dead and the patients with grade Ⅲ - Ⅴ,.6 case were dead.Conclusion It is crucial to early diagnosis and proper treatment for pancreatic trauma with high complications and high mortality,especially injured main pancreatic duct.