腹腔内应用负压封闭引流治疗严重胆胰结合部损伤

Treatment for severe injury in conjoint part of common bile duct,duodenum and pancreas by vacuum sealing drainage

目的探讨腹腔内应用负压封闭引流技术(vacuum sealing drainage,VSD)治疗严重外伤性胆胰结合部损伤价值。方法回顾分析1998年1月~2015年11月收治的10例严重胆胰结合部损伤患者的临床资料,其中男性8例,女性2例;年龄16~45岁,平均(29.00±10.39)岁。均为闭合性损伤,其中车辆方向盘致伤3例,车辆挤压伤3例,摩托车事故致伤2例,高处坠落伤2例。均行急诊手术治疗:胰腺裂伤仅进行清创、创面止血,单层缝合十二指肠的裂口,在胰腺横断处和十二指肠损伤处行VSD引流。结果手术时间60~280min,平均175min;术后无死亡,1例腹腔行VSD后因腹腔出血转外院治疗,余9例均治愈出院。腹部损伤住院时间为27~43d。术后5例出现消化液漏,其中胰漏2例,十二指肠漏1例,胰漏并十二指肠漏1例,胆漏、胰漏并十二指肠漏1例。前3例经非手术治疗治愈;后2例待腹腔负压引流管周围瘘道完整后再进行确定性手术,分别于第一次手术后第16、23天行空肠-瘘道间Roux-en-Y吻合而治愈。随访6个月~17年,无腹腔感染、腹腔积液、胰腺假性囊肿、肠梗阻等并发症发生。结论腹腔内应用负压封闭引流技术治疗严重胆胰结合部损伤疗效好。对于病情危重、难以耐受复杂手术的此类伤患者,可优先选择简单创面清创止血加VSD进行治疗。

Objective To observe the efficacy of treatment for severe injury in conjoint part of common bile duct,duodenum and pancreas by vacuum sealing drainage （ VSD）. Methods The clinical data of 10 patients with severe injury in conjoint part of common bile duct, duodenum and pancreas admitted during Jan. 1998 and Nov. 2015 was retrospectively analyzed. Among them 8 were males and 2 were females with an average of （29 ± 10. 39 ） （ 16 - 45） years. All were closed injures. Three were injured from traffic accidents ,3 from crush injury,2 from motorcycles accidents and 2 from high falling. All patients were performed the emergency operation. The pancreatic lacerated wounds were given debridement and blood-control and duodenal lacerated wound was sutured monolayer, then VSD was performed in the location of pancreatic and duodenal injury. Results Operative time was 60-280 min （average 175min）. There was no one died,and 1 patient was transferred to another hospital because of abdominal bleeding after operation,9 cases were cured. The patients＇ hospital stay was from 27 to 43 days. There were 5 cases with postoperative digestive fluid leakage,which included 2 eases of pancreatic leakage, one case of duodenal leakage, one case of pancreatic and duodenal leakage, and one case of biliary, pancreatic and duodenal leakage. All the complications were treated by VSD, the former three cases were cured nonoperatively. Pancreatic and duodenal leakage was drained from the tube of VSD in the other two patients. Approximately 16 and 23 days after the first operation when the integrated fistula tract around the tube of VSD was formed, the Roux-en-Y anastomosis between jeju- num and the fistula tract was carried out in the two cases. Patients were followed up from 6 months to 17 years;there were no intra-abdominal infections, abdominal effusion, pancreatic pseudocyst, obstruction or other complications. Conclusion The treatment for severe injury in conjoint part of common bile duct,duodenum and pancreas by VSD has good curative effects. If the patients have very dangerous conditions, they can be treated by simple debridement combined with biliary, pancreatic and duodenal trauma plus VSD.