胰腺损伤52例诊治体会

目的探讨胰腺损伤的诊断以及治疗方法。方法回顾性分析52例胰腺损伤患者的临床资料以及诊疗过程。结果本组保守治疗4例，手术治疗48例。术前腹腔穿刺液淀粉酶升高者占61．2％（19／31），血淀粉酶升高者占44．9％（13／29），B超检查阳性率为45．5％（20／44），CT检查阳性率为63．6％（21／33）。术后发生胰漏16例（33．3％），胆漏2例（4．2％），腹腔脓肿4例（8．3％），腹腔出血6例（12．5％）。死亡7例，总体死亡率为13．5％。结论胰腺损伤早期诊断困难，结合受伤史，体格检查以及淀粉酶、B超、CT等辅助检查有助于早期诊断，术中探查胰腺对于胰腺损伤的诊断最为可靠。对胰腺损伤进行准确分级，从而选择合适的治疗手段，对降低死亡率、改善患者预后具有重要临床意义。

Experience of diagnosis and treatment for 52 patients with pancreatic trauma

Objective Toexamine the diagnosis and treatment of pancreatic trauma. Methods The clinical data of 52 patients with pancreatic injury were analyzed retrospectively. Results A total of 48 patients received operation and the remaining 4 non - operative treatment. The amylase in paracentesis fluid and blood was examined before the operation and the results showed that it were increased in 61.2% （19/31）and 44.9% （13/29）patients respectively. The positive diagnosis rate was 45.5% （20/44） on B - uhrasoundexamination preoperatively and 63.6% （ 21/33 ） on CT scanning. Postoperative pancreatic fistula occurred in 16 patients（33.3% ）,biliary fistula in 2 patients（4.2% ）,abdominal abscess in 4 patients （8.3%） and abdominal hemorrhage in 6 patients （12.5%）. Seven patients died and the total mortality was 13.5%. Conclusion Early diagnosis for pancreatic trauma proves elusive. Combination of injury history, physical examination and auxiliary examination such as B - ultrasound and CT scanning is helpful for the early diagnosis. The most reliable diagnostic method is intraoperative exploration. The correct grading of pancreatic injury followed by an appropriate therapy may help decrease the mortality and improve the prognosis.