胰腺损伤临床救治及胰瘘预防研究进展

Progress in clinical treatment of pancreatic injury and prevention of pancreatic fistula

近年随着车辆事故、施工事故的增加,胰腺损伤发病率呈上升趋势。胰腺钝性闭合伤常合并其他脏器损伤,需通过动态多层螺旋CT(MSCT)、创伤超声重点评估法(FAST)协助诊断和综合评估,血清淀粉酶和脂肪酶升高具有一定临床指导价值。主要依据美国创伤外科协会制定的器官损伤分级(AAST-OIS)、合并其他脏器损伤情况、血流动力学状态3个方面选择治疗策略。树立胰瘘的三级预防思路,通过双套管持续负压灌洗和早期肠内营养支持,可显著减少胰瘘及其相关并发症。本文就胰腺损伤临床救治及胰瘘预防研究进展进行综述,以期为临床不断提高胰腺损伤治愈率提供参考。

In recent years,with the increase of vehicle accidents and construction accidents,the incidence of pancreatic injury is on the rise.Blunt pancreatic closure injury is often complicated with other organ injuries,and dynamic multi-slice spiral CT(MSCT)and Key assessment of trauma ultrasound(FAST)are needed to assist diagnosis and comprehensive evaluation.The increase of serum amylase and lipase has certain clinical guiding value.The treatment strategies were mainly selected based on three aspects:the organ injury classification(AAST-OIS),the combination of other organ injuries,and hemodynamic status formulated by the American Association for Traumatic Surgery.Pancreatic fistula and its related complications can be significantly reduced through continuous negative pressure lavage with double cannula and early enteral nutrition support.In this paper,the clinical treatment of pancreatic injury and the prevention of pancreatic fistula were reviewed,in order to provide reference for improving the clinical cure rate of pancreatic injury.