严重胰腺外伤的早期处理

Early management of severe pancreatic trauma

目的:探讨严重胰腺外伤的早期处理方法。方法:回顾性分析2006年1月—2015年4月收治的24例胰腺外伤的患者的临床资料。结果:全组24例患者中,I级损伤5例及II级损伤6例均行胰腺坏死组织清除加局部引流术;III级损伤6例均行胰腺体尾部切除术;IV级损伤7例,2例行胰十二指肠切除术,4例行胰腺空肠Roux-en-Y吻合术,1例行局部的清创引流术。全组治愈23例(95.8%),死亡1例(感染性休克),有并发症者15例(62.5%,24例次),其中胰瘘9例,创伤性胰腺炎3例,胰腺假性囊肿2例,感染2例,胆瘘1例,失血性休克1例。结论:应根据损伤程度不断调整治疗方案,选择合理的手术方式和手术时机,胰周的通畅引流和灌洗是严重胰腺外伤治疗成功保证。

Objective： To investigate the early management of severe traumatic injuries of the pancreas.Methods： The clinical data 24 patients with traumatic injuries of the pancreas treated during January 2006 to April 2015 were retrospectively analyzed.Results： In the whole group of 24 patients, 5 cases with grade I injury and 6 cases with grade II injury underwent debridement of the devitalized tissue and regional drainage, 6 cases with grade III injury received distal pancreatectomy, and of 7 cases with grade IV injury, 2 cases had pancreaticoduodenectomy, 4 cases had Roux-en-Y pancreaticojejunostomy, and one case had debridement of devitalized tissue plus drainage, respectively. Of the entire group, 23 cases were cured and one case died of septic shock. Complications occurred in 15 cases（62.5%）, which included pancreatic fistula in 9 cases, traumatic pancreatitis in 3 cases, pancreatic pseudocyst in 2 cases, infections in 2 cases, biliary fistula in one case, and hemorrhagic shock in one case, respectively.Conclusion： Continually adjusting the treatment plan according to the degree of the pancreatic damage, and choosing the appropriate operative procedure and timing, with adequate peripancreatic drainage and irrigation are critical for the successful treatment of traumatic injuries of the pancreas.