闭合性胰腺损伤32例诊断与治疗
The diagnosis and treatment of blunt pancreatic injuries: an analysis of 32 cases
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摘要: 目的:探讨闭合性胰腺损伤的诊断治疗。方法:对2005年1月至2011年7月收治的32例闭合性胰腺损伤的临床资料进行回顾分析。32例经B超检查17例,发现胰腺损伤9例;多层CT检查16例,确诊13例。非手术治疗5例,胰体尾加脾切除5例,胰腺清创引流15例,十二指肠憩室化2例,胰头部断端包埋、远端胰腺空肠Roux-en-Y吻合术4例,胰十二指肠切除1例。结果:治愈30例,治愈率93.75%,死亡2例,病死率6.25%,死亡原因为出血、多器官功能衰竭、合并其他重要脏器伤。并发胰漏3例,其中2例保守治愈,1例手术治愈;胰腺假性囊肿4例,其中2例自愈,1例穿刺引流治愈,1例手术治愈。结论:多层CT检查是胰腺损伤的重要诊断方法,胰腺损伤的部位、程度及有无主胰管损伤是决定治疗方法的重要依据,正确的围手术期处理可减少并发症,降低病死率。Abstract: Objective: To explore the diagnosis and treatment of blunt pancreatic injury. Methods: The clinical data of 32 cases with blunt pancreatic injury were retrospectively analyzed from Jan 2005 to Jul 2011. Among 32 cases,17 and 15 cases were diagnosed throngh operation and preoperative examination of B-ultrasonography and multi-layer CT respectively. Five cases with nonoperative treatment,5 cases with the tail of pancreas and spleen resecting, 15 cases with pancreatic debridement drainage,2 cases with duodenal diverticulization,4 cases with pancreatic head end embedding and far end jejunum Roux-en-Y anastomosis and 1 case with pancreaticoduodenal resection were implemented. Results: Thirty cases were cured and the cure rate was 93. 75%. Two cases died and the fatality rate was 6. 25%,which were caused by hemorrhage, infection,multiple organ failure and important organ injury. Three cases with pancreatic leakage were found and two cases cured by conservative treatment and 1 case cured by operating. Two cases of 4 cases with pancreas pseudocyst were self-healing,Its cured by puncturing drainage and operation. Conclusions: The multi-layer CT examination and exploratory laparotomy are the important method for diagnosis of pancreatic injury. The site and degrees of pancreatic injury and pancreatic duct damage are the important basis of treatment and the proper perioperative management can reduce the complications and fatality rate.