摘要
目的探讨胰腺损伤的诊断和救治策略。方法回顾性分析2006年9月至2014年12月收治的胰腺闭合性损伤45例的诊断、手术处理和预后。其中胰腺脏器损伤分级（OIS）：I级7例，Ⅱ级8例，Ⅲ级9例，Ⅳ级15例，V级6例。结果并发症12例（26．7％），胰瘘及胰腺脓肿各2例，胆瘘1例，腹腔内出血2例，腹腔内感染2例，胰腺假性囊肿1例，胰腺实质及胰周组织坏死2例。本组治愈40例（89．30A），死亡5例，死因为失血性休克、腹腔感染和多器官功能障碍综合征（MODS）。结论选择合理有效的手术方案能提高救治成功率；主胰管断裂的识别和定位是治疗成功的重要环节。胰肠吻合中使用Prolene线的连续缝合技术有助于提高疗效，减少胰瘘的发生。术后充分可靠引流对治疗效果至关重要。
Objective To explore the clinical diagnosis and surgical treatment strategies of pancreatic injury. Methods The clinical data of 45 cases of pancreatic injury in our unit from September 2006 to December 2014 were analyzed retrospectively. According to the American Association for the Surgery of Trauma-Organ Injury Scaling （AASTOIS）, there were 7 cases of pancreatic injury in grade I , 8 in grade II , 9 in grade HI, 15 in grade 1V and 6 in gradeV. All cases received operative treatment. Results Postoperative complications occurred in 12 cases （26. 7%）, including pancreatic fistula in 2 cases, pancreatic abscess in 2, bile leakage in 1, intraperitoneal hemorrhage in 2, intra-abdominal infection in 2, pancreatic pseudocyst in 1, and pancreas and peripancreatic necrosis in 2 cases. Forty cases （88. 9%） cured. Five patients died of hemorrhagic shock, peritoneal infection, intraperitoneal hemorrhage and MODS. Conclusions A proper surgical procedure can increase the success rate. Different effective operative procedures should be chosen according to the severity of pancreatic trauma. Identification and location of main pancreatic duct disruption are important determinants in the appropriate management of pancreatic trauma. Continuous anastomosis technique using prolene thread in the coarse of pancreatic drainage reconstruction can increase the therapeutic efficacy and minimize the risk of fistula. The thorough postoperative unobstructed drainage routes are critical to successful treatment.
出处
《腹部外科》
2015年第6期441-444,共4页
Journal of Abdominal Surgery
关键词
胰腺损伤
诊断
并发症
胰瘘
吻合术
Pancreatic trauma
Diagnosis
Complications
Pancreatic fistula
Anastomosis
