胰腺外伤的诊治体会

目的 总结胰腺外伤的诊治经验。方法 分析在最近5年收治的21例胰腺外伤病例资料。结果 21例患者中18例合并其它器官损伤,9例在剖腹探查术中才发现胰腺损伤。胰十二指肠切除2例、十二指肠憩室化3例、胰体尾脾切除6例、胰腺清创与外引流8例、未处理胰腺损伤2例。并发胰外瘘和胰腺假性囊肿5例。治愈16例,死亡5例。结论 胰腺外伤的合并伤多,早期诊断率低。保持对胰腺外伤的警惕,并在剖腹探查术中常规探查胰腺是早期发现和避免漏诊胰腺外伤的关键。术式的选择应综合考虑胰腺损伤的程度、部位、有无主胰管损伤、以及合并伤的伤情。并发症主要是胰外瘘和胰腺假性囊肿。     

胰腺外伤诊治的近况

胰腺外伤不多见，诊断及时或延迟，治疗恰当或不合理，两者的预后有天壤之 ，如延误 治疗不及时会带来很多并发症，死亡率也增高，如能早期确诊，初步治疗合理、伤员多能顺利恢复。本综述重点介绍胰腺外伤的分类及其处理原则，帮助临床医生熟悉这方面情况。     

胰腺损伤20例诊治体会

目的探讨胰腺损伤的诊断和治疗。方法选择近10年我院收治的20例胰腺损伤病例进行回顾性分析。结果本组20例中治愈18例占90％；死亡2例占10％。胰腺损伤或合并多器官损伤者死亡率高。结论早期准确的诊断和正确及时的治疗是提高治愈率、减少死亡率的关键。手术是治疗胰腺损伤的主要方式。     

胰腺外伤21例诊治体会

目的 探讨胰腺外伤的外科治疗方法.方法 回顾分析我院1996年8月至2010年6月收治的21例胰腺外伤患者的临床资料.结果 术前13例行CT检查,7例考虑有胰腺损伤,阳性率53.8%;14例行B超检查,2例考虑为胰腺损伤;腹腔穿刺液13例查淀粉酶,9例明显升高;1例漏诊,其余均经术中探查确诊.本组均采用手术治疗,手术方式:单纯引流4例,胰腺缝合修补7例,胰体尾切除6例,胰体尾断端与空肠行Roux-Y吻合术2例,胰十二指肠切除术1例,胰头清创缝合加十二指肠改良憩室化手术1例,治愈18例,死亡3例.结论 腹腔淀粉酶测定和CT联合应用可提高胰腺损伤的早期诊断率,术中仔细探查胰腺是防止遗漏胰腺损伤的重要措施,以损伤控制性手术治疗原则为主的综合治疗可提高胰腺损伤的治愈率.     

胰腺外伤诊治的近况

胰腺外伤不多见，诊断及时或延迟，治疗恰当或不合理，两者的预后有天壤之别。如延误诊断或治疗不及时会带来很多并发症，死亡率也增高；如能早期确诊，初步治疗合理，伤员多能顺利恢复。本综述重点介绍胰腺外伤的分类及其处理原则，帮助临床医生熟悉这方面情况。     

胰腺外伤的外科治疗

作者报道了163例胰腺外伤患者的外科治疗情况。根据Lucas标准分类，Ⅰ度胰腺外伤35例，Ⅱ、Ⅲ、Ⅳ度分别为92例、胰体尾切除(45例)、胰腺挫裂伤修补(74例)、胰腺清创(20例)等手术。全组死亡11例(7％)，术后并发胰26例(16.5%)、肠瘘6例(3.8%)、腹腔脓肿9例(5.7％)、胰腺假性囊肿4例(2.5％)和其它并发症。作者认为腹部外伤时要重视胰腺损伤的存在。根据胰腺外伤程度合理选择手术方式是降低胰腺外伤死亡率及并发症率的关键。     

胰腺外伤并发胰瘘的诊治经验

目的 为了解胰腺损伤并发胰瘘的病情发展过程，总结其诊治经验，方法 对近１０年来的７例胰膛损伤并发胰兼思者的治疗过程进行总结，结果 发展以男性青壮年为主；致伤原因多为上腹部及腰背撞伤，挤压伤，胰瘘自愈时间平均７７．４天，结论 （１）胰腺损伤早期诊断有待努力，（２）胰腺损伤越重，越近胰头，手术越迟瘘量越大；（３）胰瘘量的多少与胰瘘自愈时间无明确关系，胰瘘量越并不表示自愈的可能性越小或时间越长；（４）胰     

胰腺外伤的诊治体会

目的 :探讨胰腺外伤的诊断、治疗和预后。方法 :回顾性分析 2 3例闭合性腹外伤致胰腺外伤的诊断、治疗的临床资料。结果 :入院时经CT检查 18例患者 ,明确胰腺损伤诊断者 13例。 2 3例患者均行诊断性腹腔穿刺 ,17例患者抽出不凝血。首诊漏诊 10例 ,漏诊率 43 %。手术治疗 17例 ,保守治疗 6例。手术组并发胰漏 4例 ,胰腺囊肿形成 1例 ,腹腔感染 3例 ,死亡 3例。保守治疗组胰腺假性囊肿形成 4例 ,合并感染 2例 ,创伤性胰腺炎 1例 ,囊肿择期手术致胰漏 1例。结论 :闭合性腹外伤致胰腺外伤早期明确诊断较为困难 ,易漏诊 ,延误治疗。在治疗上因损伤的个体差异大 ,故手术方式的选择应视具体胰腺损伤的性质、部位及合并损伤的脏器而个体化。通畅有效的引流可降低感染、脓腔形成等并发症的发生率 ,并关系到胰漏的早期愈合。双套管持续冲洗及负压引流是一种有效可靠引流方式。对于术中发现胰腺部位腹膜后血肿者应积极的探查 ,以便能及时发现胰腺损伤 ,正确处理。保守观察的患者应及时的复查CT、B超、血 尿淀粉酶 ,以便能及时准确的处理     

胰腺损伤28例诊治分析

目的 提高和改善胰腺损伤的诊断水平和疗效. 方法 回顾性分析1999至2011年收治的28例胰腺损伤病人的临床资料.结果 本组患者中2例为开放性胰腺损伤,26例为闭合性胰腺损伤.单纯胰腺损伤14例,伴有腹腔内其他脏器损伤14例.根据AAST分级按照选择保守治疗或手术治疗,术后并发胰瘘7例,死亡1例. 结论 胰腺损伤诊治困难,并发症的发生率高,CT是目前诊断胰腺损伤的主要手段;根据胰腺损伤的分级,采用合适的治疗方式,可减少并发症,提高救治率.     

Treatment of abdominal injuries: a report of 522 cases

OBJECTIVE: To make a summary of the experiences in the treatment of abdominal injuries. METHODS: A retrospective study was done on 522 cases of abdominal injuries in our department from January 1986 to December 2004. RESULTS: Of all,382 cases were treated by surgery and 140 by conservative method. Among the surgically treated cases, 347 patients (90.8%) recovered, 35(9.2%) died and 21 had postoperative complications (5.6%). For patients undergoing conservative treatment, 139(99.3%) recovered but one (0.7%) died. CONCLUSIONS: The severity of abdominal injury and delayed treatment are two key factors leading to death. Surgical procedure is still the main method against alternative abdominal injuries. It is necessary to strictly control the indications in conservative treatment.     

腹腔镜在腹部外伤中的应用(附15例报告)

目的 :研究腹腔镜治疗腹外伤的优越性。方法 :为 15例腹外伤患者进行腹腔镜探查和治疗。结果 :探查 15例 ,均明确诊断。腹腔镜下治疗 3例 ,中转开腹 5例 ,使 10例患者避免了不必要的开腹手术 ,5例患者及时开腹治疗 ,无并发症和死亡病例。结论 :腹腔镜应用于治疗腹外伤中 ,使部分患者免于不必要的开腹 ,避免盲目观察而延误病情 ,使部分患者进腹手术前明确了病变位置     

胰腺中段切除术在胰腺颈体部良性肿瘤的应用(附15例报告)

目的 探讨胰腺中段切除术在胰腺颈体部良性肿瘤中的临床实用价值.方法 对2005年11月至2009年6月期间收治的胰腺颈体部良性肿瘤并施行胰腺中段切除术的15例病例进行回顾性分析,男性3例,女性12例,年龄30～55岁,平均45岁.其中因上腹部胀痛不适入院4例,其余11例均为常规体检行腹部彩色超声检查发现.结果 本组患者无围手术期死亡.15例患者均行胰腺中段切除,其中14例行胰头断端闭锁、胰尾空肠吻术(单吻合术),1例行胰腺两断端空肠"Ω"吻合(双吻合术).术后病理检查结果显示,胰腺实性假乳头状瘤1例,无功能性胰岛细胞瘤3例,胰腺囊腺瘤11例.术后发生胰瘘3例,均在3个月内自行愈合.所有患者均获得随访,随访时间2～45个月,15例患者无死亡,无新发糖尿病,无肿瘤再发,无胰腺假性囊肿形成.结论 胰腺中段切除术治疗胰腺颈体部良性肿瘤临床效果确切,对患者内、外分泌功能影响小,胰瘘发生率高于胰头十二指肠切除术,只要通畅引流,多能自行愈合.     

手部套脱伤的分型与程序化治疗临床应用研究

目的 探讨手部皮肤套脱伤的分型与治疗方式.方法 依据不同的伤情与手术治疗方法,将手部套脱伤分为六种类型.针对不同分型,提出程序化治疗的概念,采取点对点的应对措施,并使用了阶梯式修复血管、交替式切口清创、局限性缝合固定、区域性加压包扎及散在性切口引流等技术.结果 本组共144例,获得10年以上随访49例,5年42例,3年24例,1年20例,5个月9例.15例全手套脱伤中仅1例手背部分皮肤作了游离植皮治疗,小指部分坏死作了截指;其他类型的皮肤撕脱和手指套脱伤经治疗全部存活.皮肤外形美观,耐磨擦能力强,基本恢复了原来的手功能.结论 手部套脱伤六型分类法切合临床实际,程序化治疗采用点对点的应对措施,便于临床迅速展开救治.其中的关键技术解决了手部套脱伤手术中的技术难题,术中、术后相关辅助措施进一步提高了手部皮肤套脱伤治疗的成活率.程序化治疗为临床手部套脱伤的救治开辟了一条全新的途径.     

胰十二指肠切除术后吻合口裂开的预防与治疗策略

胰十二指肠切除术后吻合口裂开合并腹腔大出血是严重威胁患者生命的致死性术后并发症.因此,胰十二指肠切除术后吻合口裂开和继发腹腔大出血的预防与治疗,一直是胰腺外科争论的焦点.手术处理术后并发症仍然是最为稳妥的治疗方法.但再次手术探查难度较大、方法多变且不易掌握,术后有再次发生吻合口瘘和出血的危险,有些术式可能损害胰腺全部内、外分泌功能.我们对多例胰十二指肠切除术后发生腹腔大出血患者施行主胰管空肠桥式导管引流术,患者术后效果良好,救治率达100％.该术式操作简便、安全性高、救治率高,还可保留剩余胰腺功能,是一种简易可行的应急手术方法.     

Surgical management of transected injury to the pancreatic neck

Objective: To present a batch of data of transected pancreatic neck injuries and to sum up the experience insurgical interventions for the in juries. Methods. We analysed 13 patients with a transected injury to the pancreatic neck from Jan. 1995 to Dec. 2000.External drainage was performed in all patients.Pancreatoduodenectomy was conducted in 2 patients with a transected injury to the pancreatic neck associated with duodenal ruptures, and TPN was administered immediately after operation. Proximal closure of the transected margin and distal pancreaticojejunostomy was performed in 4 patients. Proximal closure of the transected margin and distal pancreaticojejunostomy plus splenectomy was performed in 7 patients associated with contusion of pancreatic body or tail plus spleen rupture. Results : 12 patients healed and one patient died of anesthetic accident during the course of restoration of the dislocation of his right hip joint. Complicatious occurred in 7 patients. Conclusions: The operation should be performed according to the degree of the injuries and associated duodenal injuries. Routine drainage and nutrient support should be recommended.     

胰腺损伤术后早期胃肠外营养支持治疗体会

目的　探讨胰腺损伤术后早期胃肠外营养支持的作用。方法　回顾性分析我们近 6年来收治的 1 5例胰腺损伤术后病人进行早期胃肠外营养支持 (PN)的临床资料。结果　治愈 1 4例 ,发生并发症 2例次。腹腔液淀粉酶显著下降 ,肝、肾功能好转 ,血糖渐趋正常 ,血清白蛋白、转铁蛋白、前白蛋白均明显提高。结论　胰腺损伤术后胃肠外营养支持有利于促进创伤愈合 ,减少并发症的发生     

腹腔镜在单纯性腹部锐器伤中的应用及意义(附31例报告)

目的 :研究腹腔镜治疗单纯性腹部锐器伤的优越性。方法 :应用腹腔镜对 31例单纯性腹部锐器伤患者行急诊探查术。结果 :腹腔镜完成 2 9例 ,中转开腹 2例 ,2例明确了诊断 ,近远期随访无 1例发生并发症和死亡。结论 :在单纯性腹部锐器伤时应用腹腔镜 ,不仅减少了患者的痛苦 ,且为治疗明确了诊断     

Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre

Introduction

Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM.

Methods

A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013.

Results

Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the non-operated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05).

Conclusions

SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.     

Primary mesenchymal chondrosarcoma of the pancreas

Extraskeletal chondrosarcomas are rare and there is only one reported case of primary pancreatic chondrosarcoma. We report the case of a 34-year-old woman with a 6-month history of abdominal pain and distention. Radiological studies indicated a mass in the pancreas, and exploratory laparotomy revealed a tumour of the pancreas extending to the hepatic vessels and hepatoduodenal ligament. The mass was completely excised, and the histopathological diagnosis was primary mesenchymal pancreatic chondrosarcoma. Tumour recurred at follow-up 52 months postoperatively.