30例胰腺外伤的诊疗分析

Diagnosis and treatment of 30 cases of pancreatic trauma

目的：探讨胰腺外伤的临床诊疗体会。方法：采用回顾性分析的方法，对2015年5月～2016年10月于我院普外科收治的30例胰腺外伤患者的一般资料、诊断方法、手术方法及手术效果、并发症等进行分析和总结。结果：30例胰腺外伤患者中，根据胰腺损伤标准（AAST-OIS）分级：Ⅰ度损伤13例，Ⅱ度11例，Ⅲ度4例，Ⅳ度2例。治愈28例（治愈率为93．3％）；死亡2例（死亡率为6．7％），其中1例胰腺外伤患者是在手术中由于失血休克并多脏器损伤而至死亡，1例是于手术后因诱发多器官衰竭死亡。此外，手术治疗后，有11例患者出现严重的并发症，包括胰瘘3例，腹腔囊肿4例，假性胰腺囊肿2例，胰腺出血2例。结论：在胰腺外伤诊疗中，诊疗成功的关键一方面是要综合患者各方面资料以做出准确诊断，另一方面是要在手术中正确判断患者是否合并有主胰管损伤并放置充分、有效的引流。

Objective： ： To investigate the clinical diagnosis and treatment of pancreatic trauma. Methods： Retrospective analysis, general data, diagnosis method and operation method of 30 cases of pancreatic trauma patients from May 2015 to October 2016 in the De- partment of general surgery in our hospital and surgical results and complications were analyzed and summarized. Results： in 30 patients with pancreatic trauma, according to the criteria of pancreatic injury （AAST - OIS）, there were 13 cases of first degree injury, 2 cases of grade II （ ） , three cases of grade III（ n = 4 ）, and 4% of the cases. 28 cases were cured （ cure rate 93.3% ） ; 2 cases died （ mortality 6.7% ） , including 1 cases of pancreatic trauma patients during surgery due to hemorrhagic shock and multiple organ injury and death, 1 eases are in operation due to multiple organ failure induced by death. In addition, there were 11 cases of severe complications after surger- y, including pancreatic fistula in 3 cases, abdominal cyst in 4 cases, pancreatic pseudocyst in 2 cases, pancreatic hemorrhage in 2 cases. Conclusion： in the diagnosis and treatment of pancreatic trauma, diagnosis and treatment was the key to the success of a comprehensive information on all aspects of patients to make accurate diagnosis, on the other hand was to correctly determine whether the patients in sur- gery with the main pancreatic duct injury and drainage sufficient and effective.