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严重复杂的胰腺创伤临床处理探讨 被引量:7

Analysis of clinical management for severe and complicated pancreatic trauma
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摘要 目的 总结严重复杂性胰腺损伤的诊治经验.方法 回顾性分析21例的临床资料.其中男14例,女7例;年龄9~53岁,平均26岁;损伤分级:Ⅲ级8例,Ⅳ级8例,V级5例.主要诊断方法有淀粉酶测定、B超、CT、ERCP和MRCP等.均采取手术治疗,10例行远侧胰腺空肠Rouxen-Y吻合术;3例行胰头十二指肠切除术;2例行改良十二指肠憩室化手术;3例行胰腺尾部切除术;2例行胰腺断面缝合、主胰管内置管外引流;1例行胰腺两侧断端缝扎,后二期手术行远端胰腺空肠吻合术.结果 术前诊断明确11例,术中确诊10例.18例损伤后12 h内手术治疗,3例延期手术治疗.治愈20例,病死1例(胰头十二指肠切除术后).发生胰瘘并发症3例,经充分引流、药物治疗治愈.结论 胰腺严重创伤的诊断率仍较低,早期应积极剖腹探查弥补术前诊断的不足,手术方式要根据分级采取个体化方案,贯彻损伤控制性外科理念,不宜盲目扩大手术. Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.
出处 《中华肝胆外科杂志》 CAS CSCD 北大核心 2010年第6期401-403,共3页 Chinese Journal of Hepatobiliary Surgery
关键词 创伤和损伤 胰腺 诊断 治疗 Wounds and injuris, pancreatic Diagnosis Treatment
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  • 1高晓瑜,李国旗.急性胰腺断裂的超声诊断分析[J].中国超声医学杂志,2004,20(11):864-865. 被引量:4
  • 2刘震杰,沈来根.胰腺假性囊肿的治疗现状及进展[J].国际外科学杂志,2006,33(3):189-192. 被引量:12
  • 3Timberlake GA.Blunt pancreatic trauma experience at a rural referal center.Am Surg,1997,63:282-286.
  • 4Bradley EL,Young PR,Chang MC. Diagnosis and initial management of blunt pancreatic trauma guidelines from a multi-in-stitutional review. Ann Surg,1998,227:861-869.
  • 5Hata M,Murao Y,Konobu T,et al. Laparoscopic treatment for peripheral pancreatic duct injury after blunt abdominal trauma: report of a case. Surg Today, 2002,32:659-662.
  • 6Sayad P,Cacchione R,Ferzli G.Laparoscopic distal pancreatectomy for blunt injury to the pancreas: a case report. Surg Endosc, 2001,15:759.
  • 7Coppola V,Vallone G,Verrengia D,et al.Pancreatic fractures:the role of CT and the indications for endoscopic retrograde pancreatography.Radiol Med,1997,94:335-340.
  • 8Bigattini D,Boverie JH,Dondelinger RF.CT of blunt trauma of the pancreas in adults.Eur Radiol,1999,9:244-249.
  • 9Kouraklis G,Spirakos S,Glinavou A.Damage control surgery:an alternative approach for the management of critically injured patients[J].Surg Today,2002,32 (3):195-202.
  • 10Madding GF.Injuries of the liver[J].Arch Surg,1955,70:748 -756.

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