15例闭合性胰腺损伤的外科诊治分析

Surgical diagnosis and management of 15 patients with blunt pancreatic trauma

目的 总结闭合性胰腺损伤外科治疗的经验及体会。方法 回顾性收集汕头大学附属粤北人民医院肝胆外科2010年1月至2021年4月期间收治的15例行外科治疗的闭合性胰腺损伤患者的临床资料,分析闭合性胰腺损伤的受伤原因、早期诊断方法、外科治疗结果、并发症的处理等。结果 15例闭合性胰腺损伤患者的受伤方式:交通伤7例(车把手伤5例),高处坠落伤4例,重物撞击伤3例,挤压伤1例。胰腺损伤分级:Ⅱ级5例,Ⅲ级7例,Ⅳ级2例,Ⅴ级1例。7例入院时血清淀粉酶值大于参考值上限(104 U/L)4倍以上者、8例行增强CT者术前均确诊胰腺损伤。2例行胰十二指肠切除术,2例行胰周血肿清除术+胰管-空肠吻合术,7例行远端胰腺切除术,2例行胰腺裂伤缝合止血术,2例行胰腺坏死清除术。1例死于复合伤并出血。并发症:生化瘘5例,B级胰瘘3例,C级胰瘘1例,假性囊肿1例,腹腔假性动脉瘤并出血1例。结论 应结合患者受伤史、血清淀粉酶水平及腹部增强CT对胰腺损伤进行早期诊断及分级,对于高级别胰腺损伤应尽早外科干预。

Objective To summarize the experience of surgical diagnosis and management of patients with blunt pancreatic trauma. Methods The clinical data of 15 patients with blunt pancreatic trauma who underwent surgical treatment in the Yuebei People’s Hospital from January 2019 to April 2021 were retrospectively collected. The injury causes, early diagnostic methods, surgical treatment results, and major complications of patients with blunt pancreatic trauma were analyzed. Results The causes of blunt pancreatic trauma: traffic accident injury(seven patients), falling injury(four patients), impact injury(three patients), and crush injury(one patient). Organ Injury Scale grading system of the American Association for the Surgery of Trauma grading of pancreatic trauma: grade Ⅱ(five patients), grade Ⅲ(seven patients), grade Ⅳ(two patients), and grade Ⅴ(one patient). The patients whose serum amylase value was more than four times of reference value(104 U/L) or who underwent enhanced CT were diagnosed with pancreatic trauma before operation. Two patients underwent pancreatoduodenectomy, two patients underwent removal of peripancreatic hematoma+pancreaticojejunostomy, seven patients underwent distal pancreatectomy, two patients underwent suture hemostasis of pancreas, two patients underwent clearance and drainage of pancreatic necrosis. One patient died of combined injury and bleeding. Major complications: five patients suffered from biochemical leakage, three patients suffered from grade B and one patient suffered from grade C pancreatic fistula, one patient suffered from abdominal pseudoaneurysm and hemorrhage. Conclusions The early diagnosis and grading of pancreatic injury should be combined with the history of injury, serum amylase level, and abdominal enhanced CT. Surgical intervention should be carried out as early as possible for high-grade pancreatic trauma.