胰腺损伤的外科治疗

９年中，有１２例胰腺创伤后手术治疗，１１例（９１．７％）为钝性胰腺损伤，仅有１例（８．３％）为开放性损伤（刺伤），除１例外余１１例（９１．７％）伴有其经脏器损伤，脾脏及肝脏为最常见的受累及脏器。根据Ｍｏｏｒｅ胰腺损伤分类法，，４例Ⅰ－Ⅱ度胰损伤，行清创及腹腔外引流，其中１例术后并发创伤性胰腺炎；４例Ⅲ度损伤行远侧胰体尾发体除，术后有２例发生胰瘘，１例Ⅳ度损伤及１例Ⅲ度损伤均行Ｌｅｔｔｏｎ－Ｗｉｌｌ     

胰腺肿块手术中大静脉损伤的处理

胰腺与腹腔多条大静脉毗邻,在施行胰头部（壶腹、壶腹周围）及胰体尾部肿块手术的探查和切除过程中,这些壁薄的静脉有可能损伤。我们曾遇到９例,均成功地处理了损伤,其中８例完成了拟施手术。临床资料男６例,女３例,年龄３２～７０岁。胰肿块包括胰头癌４例、胰体尾部巨大假性囊肿２例、胰体尾癌、胰头部炎性肿块及胆总管癌各１例。行胰十二指肠切除５例、胰体尾部切除３例、胃空肠吻合１例。１．静脉损伤部位及有关情况门静脉２例、肠系膜上静脉４例、肠系膜下静脉１例、脾静脉２例,均系静脉侧壁损伤。损伤裂口长度：正例０．３ｃｍ…     

胰十二指肠损伤32例处理经验

胰十二指肠位于上腹深部,损伤机会虽较少,但诊断和处理比较困难,死亡率高达２０％。我科１９７３年８月～１９９７年１２月共收治不同类型胰十二指肠损伤３２例,均经手术治愈。现将处理经验报道如下。临床资料本组３２例中,闭合性损伤２９例,开放伤３例。男性２６例,女６例。年龄８～５７岁。损伤程度：胰腺单纯挫伤２例;挫裂伤３例;横断伤６例,部分断裂伤１例;胰头十二指肠损伤９例,十二指肠２、３部破裂１１例。合并有肝损伤２例,脾损伤４例,肾损伤５例,胃挫伤４例,腹膜后大血肿２例。损伤部位、手术方式见表贝。３２例中…     

闭合性胰十二指肠损伤的处理

本文报告９例闭合性胰十二指肠损伤，对手术术式，术后并发症及治疗进行讨论，提出：（１）上腹受钝性暴力后怀疑有胰十二指肠损伤时应及时剖腹探查；（２）十二指肠损伤除轻度裂伤外，一般不用修补缝合，以免发生肠瘘，胰管断裂或严重胰腺断裂应行近端缝合，远端与空肠吻合，胰头十二指肠严重损伤时，选用胰十二指肠切除宜慎重；（３）营养支持对损伤的愈合有益。     

胰腺外伤7例诊治体会

胰腺外伤比较少见，约占腹部外伤的1％～2％，但近年来，由于交通事故增多，有增长趋势，约占腹腔内脏损伤的8％～12％。该病诊断困难，治疗难度大，并发症多，病死率高达20％。我们于1989年9月至1996年10月共收治7例不同类型胰腺外伤，均经手术治愈。1临床资料本组7例，男性6例，女性1例，年龄18～54岁；损伤类型：胰腺体部裂伤1例，胰体尾部纵轴裂伤1例，胰体尾横断伤1例，胰尾部断裂伤1例，胰腺挫伤2例，胰体尾部锐物刺伤1例，均行手术治疗。手术方法：胰体尾加脾切除2例，胰尾切除加牌切除1例，双套管引流3例，胰修补加外弓D流1例。2讨…     

12例胃肠道异位胰腺手术治疗体会

１２例胃肠道异位胰腺手术治疗体会王心存，张启林胃肠道异位胰腺。２０年来我科共收治１２例胃肠道并施行了手术治疗，现报告如下。１．临床资料：本组男８例，女４例，年龄１８～６４岁。其中见于胃窦部５例；十二指肠４例；空肠１例；回肠２例。位于胃、十二指肠异位胰...     

胰腺损伤手术中几个难点处理体会

报告胰腺损伤４９例，均采用手术治疗。止血、引流３２例；胰体尾切除５例；近端主胰管结扎，远端胰空肠吻合３例；改良十二指肠经手术４例，Ｗｈｉｐｐｌｅ手术３例；主胰管吻合２例。死亡２例（１８．４％）。本文重点介绍：１．主胰管损伤可通过肉眼观察，经胆囊径路造影或其美兰注射而确诊，胰管吻合是一种值得推崇的术式．２．重度胰十二指肠联合损伤处理困难，当视具体情况采用改良十二指肠憩室手术或Ｗｈｉｐｐｌｅ手术。３．     

胰十二指肠损伤术后早期肠内营养的应用体会

胰腺、十二指肠损伤是较复杂的腹部损伤之一，无论是诊断及治疗均有许多亟待改进之处。近年来，我们将手术后早期肠内营养应用于此种损伤的治疗中，取得了良好效果，现报到如下。１　资料与方法１．１　一般资料本组７例，男６例，女１例。年龄２１岁～５２岁。致伤原因：车祸伤５例，打击伤１例，刀刺伤１例。损伤部位：十二指肠降部并胰头部挫裂伤４例，十二指球部、升部破裂并胰头颈部裂伤１例，十二指肠降部破裂１例，胰体尾挫裂伤１例。合并伤：血气胸及肋骨骨折２例，肝破裂２例，颅脑及颌面部外伤、胫骨开放性骨折、脾破裂、胃破裂、…     

非功能性胰岛细胞瘤的诊断与治疗(附27例报告)

１９８１～１９９６年收治非功能性胰岛细胞瘤２７例。首发症状为腹部肿块１０例，腹部不适与肿块１１例，急性胰腺炎表现者３例，腹部不适与梗阻性黄疸者３例。行Ｂ超检查２７例中２０例（７４．１％）定位准确。行ＣＴ检查１５例均显示肿物，１３例（８６．７％）定位准确。行ＥＲＰ检查４例，于肿物存在部位主胰管受压、移位。２７例中肿瘤位于胰头部１５例，恶性４例中２例行胰头十二指肠切除术，２例行探查术；良性１１例中６例行肿瘤摘除，５例行胰头十二指肠切除术。肿瘤位于胰体尾部１２例均为良性，１０例行包括肿瘤在内的远侧胰腺及脾切除术，肿瘤摘除及保留脾脏的胰体尾切除术各１例。全组无手术死亡。随访：良性肿瘤２３例术后随访４个月至１５年均存活。恶性４例中２例行胰头十二指肠切除术后随访４～５年存活，行探查术２例于术后６及９个月死于癌转移。     

胰十二指肠合并伤的外科治疗体会

目的 探讨胰十二指肠外伤后手术方式的选择和手术效果。方法 对１９８８￣１９９８年１０年间手术治疗的８例胰十二指肠合并伤病人的临床资料进行了回顾性分析。结果：①１０年间收治胰腺外伤３２例,其中胰十二指肠合并伤８例（２６％）;②术前均未明确诊断,术中１例漏诊;③在十二指肠损伤修补的基础上,行胰腺清创６例,胰腺次全切除１例,胰尾加脾切除１例,其中５例行十二指肠憩室化术。④术后胰瘘４例,十二指肠瘘２例,腹     

胰腺损伤的诊断和治疗(附32例报告)

本文报告胰腺损伤32例,均经手术治疗。其中胰腺挫伤小网膜腔行腹腔引流术13例,胰腺挫裂伤行清创缝合及引流术10例,胰腺十二指肠联合伤行十二指肠憩室化手术2例,均治愈。7例胰腺横断伤中,行近端胰腺缝合及远端胰切除加脾切除术或远端胰空肠Roux-en-Y吻合术各3例,均治愈;1例行胰腺对端吻合术,术后因胰瘘、胰源性腹膜死亡。     

医源性胆胰肠结合部损伤的诊治体会

目的总结医源性胆胰肠结合部（CPDJ）损伤的诊治体会。方法回顾性分析2000年3月至2011年9月期间我院收治的9例CPDJ损伤患者的临床资料。结果 9例CPDJ损伤患者术中均放置双套管引流,术后均给予营养支持及抑制胰腺分泌治疗。①有6例术中即时发现,其中单纯胆总管下端后壁穿孔2例、单纯十二指肠壁穿孔者2例,均给予修补、胆总管T管支撑引流、腹腔引流;胆管或十二指肠损伤合并胰腺挫伤者2例,均行端侧胆肠吻合术＋毕Ⅱ氏胃空肠吻合术。该6例CPDJ损伤患者无一例死亡。②有3例术后发现,其中2例胆总管下端、十二指肠穿透伤合并胰腺挫伤,1例行全胆汁改道术后发生腹腔感染、十二指肠瘘、伤口裂开、腹腔和上消化道出血、多器官功能衰竭而死亡,另1例行全胆汁改道同时加做十二指肠憩室化手术后治愈;1例行十二指肠巨大间质细胞瘤手术致胆总管下端梗阻,先行经皮经肝胆管引流术,再行胆肠吻合术后治愈。结论 CPDJ损伤是一种发生于胆道手术、内镜下括约肌切开术、十二指肠手术中的损伤,术中易漏诊,可产生严重后果,应根据术中损伤的单纯性或复合性及术后发现的具体情况作相应的治疗。     

严重十二指肠损伤的治疗

目的探讨严重十二指肠损伤的治疗方法。方法回顾8年间手术治疗的严重十二指肠损伤和胰腺损伤38例患者的临床资料。结果十二指肠憩室化手术8例,5例痊愈,2例肠瘘,死亡1例。胰十二指肠切除9例,3例痊愈,胰瘘6例其中死亡3例。十二指肠直接修补或补片修补16例,13例痊愈,2例发生肠瘘,死亡1例。5例十二指肠修补+胰头切除胰腺空肠吻合(保留十二指肠的胰头切除),4例痊愈,1例胰瘘;其中3例行胰腺空肠捆绑吻合患者,无胰瘘发生,均痊愈出院。结论大部分十二指肠损伤可行十二指肠直接修补或补片修补加可靠的十二指肠和空肠造瘘术;对合并严重胰头部损伤者可在上述手术基础上行保留十二指肠的胰头切除,可获得比较满意的效果。不要轻易使用十二指肠憩室化手术和胰十二指肠切除手术。     

Blunt injuries of the pancreas in children]

STUDY AIM: Conservative management is mainly proposed for pancreatic trauma without ductal injuries. The aim of this retrospective study was to assess our experience with traumatic pancreatic injuries and to compare patients with medical or surgical treatment. PATIENTS AND METHOD: From January 1989 to December 1998, 21 children, 13 boys and 8 girls with a mean age of 8 years (range: 1 to 17 years) were treated for pancreatic injuries. Main mechanisms of injuries were bicycle's falls (n = 7), passengers in motor vehicle collision (n = 6), and other road collisions (n = 5). Diagnosis of pancreatic trauma in 17 patients was made through ultrasonography and/or CT scan. In 4 patients, the diagnosis was made intraoperatively. Associated injuries were splenic (n = 6), hepatic (n = 5) and duodenal (n = 5). Thirteen patients had only medical treatment and 8 patients required laparotomy. The two groups were comparable according to the rate of high grade pancreatic lesions. RESULTS: Two complications, a pancreatic fistula and a pseudocyst, occurred in the operative group and improved spontaneously. One death due to a head trauma, one acute pancreatitis and seven pancreatic pseudocysts (six required percutaneous drainage), occurred after medical treatment. The mean hospital stay, shorter after medical treatment, was not significantly different between the two groups (26 days vs 32 days). During the follow-up, no late complications have been observed. CONCLUSION: Traumatic pancreatic injuries are rarely lethal but are often associated with other intra-abdominal injuries. Conservative treatment is advocated for grade 1 to 4 isolated pancreatic injuries. This conservative approach may be associated with the development of post-traumatic pancreatic pseudocysts which are easily cured by percutaneous drainage.     

双U套入荷包捆绑式胰肠吻合术在IV、V 型胰腺外伤中的应用

目的:探讨双U套入荷包捆绑式胰肠吻合术在胰腺外伤中的应用价值。方法:回顾性分析2011年1月—2015年1月收治的9例IV、V型胰腺外伤患者的临床资料。结果:胰腺外伤IV型7例,其中5例行胰头断端缝闭(U形交锁+连续缝扎),双U套入荷包捆绑式胰体尾空肠Roux-en-Y内引流术后治愈;2例合并十二指肠碎裂伤行胰十二指肠切除术、双U套入荷包捆绑式胰肠吻合术后治愈。V型患者2例,均行胰十二指肠切除术、双U套入荷包捆绑式胰肠吻合术后治愈。全组患者术后均未出现胰瘘、吻合口出血等严重并发症。所有患者均获得随访,一般情况良好,均无糖尿病、腹泻、消化不良等胰腺功能减退情况发生,无死亡。结论:双U套入荷包捆绑式胰肠吻合法在胰腺外伤手术中是可行的,能够有效的防止术后胰瘘的发生。     

胰肾联合移植术后外科并发症的单中心临床分析

目的 对单中心胰肾联合移植术后外科并发症的发生及预后进行评价.方法 因糖尿病合并终末期肾病接受胰肾联合移植的患者共40例,统计患者术后发生的外科并发症以及再次手术治疗的并发症.结果 术后出现需要临床处理的严重血尿4例,其中1例经手术行供者十二指肠置管冲洗后止血,2例予持续膀胱冲洗后止血,1例供者十二指肠与膀胱吻合口小动脉出血,手术止血.4例患者出现腹腔内出血,3例为胰腺出血,1例为十二指肠肌层出血,均经手术止血.腹腔感染8例,1例死于多脏器功能衰竭,2例行脓肿穿刺引流后治愈,2例经手术清除脓肿,3例给予抗生素治疗后治愈.术后出现吻合口瘘1例,致胰腺切除.肠梗阻4例,予中药灌肠后治愈.肺部感染7例,均为细菌感染,其中1例合并真菌感染,经抗感染治疗后治愈.另出现伤口愈合不良5例,泌尿系感染2例.胰肾联合移植术后因外科并发症再手术者共10例(14次),再手术率为25%(10/40),主要包括血尿2例(4次手术),腹腔出血4例,腹腔感染2例(3次),胰腺静脉血栓形成、吻合口漏及胰瘘各1例.结论 胰肾联合移植术后外科并发症主要包括血尿、腹腔出血、腹腔感染等,是影响胰移植物短期存活率的重要因素.

Abstract：

Objective To analyze the complications, treatments and prognosis of simultaneous pancreas-kidney transplantation. Methods Forty cases of simultaneous pancreas-kidney transplantation performed between Dec. 1999 and Jan. 2010 in our center were retrospectively analyzed. Results Regarding surgical complications, 4 cases had severe hematuria after operation,which needed clinical intervention, including 1 patient receiving catheterization in duodenum to stop bleeding. Two patients were treated with continuous bladder irrigation, and the remaining one received surgical haemostasis because of donor's duodenum and bladder anastomotic artery hemorrhage.Abdominal hemorrhage occurred in 4 patients, including pancreatic hemorrhage in 3 cases and duodenal muscularis hemorrhage in one case. All of them received surgical treatment for hemostasis.Abdominal infection occurred in 8 cases: one died of multiple organ failure, 2 cases were cured after drainage of abscess, 2 cases underwent surgical removal of abscess, and 3 cases were cured after antibiotic therapy. In one case of postoperative anastomotic leakage, pancreas was resected. Four cases of postoperative ileus were cured by continuous clysis with traditional Chinese medicine. Seven cases had pulmonary bacterial infections, including one cases associated with fungal infection. They were cured by the anti-infective treatment. Other complication included poor healing in 5 cases and urinary infection in 2 cases. After combined simultaneous pancreas-kidney transplantation, 10 patients received reoperation because of surgical complications (14 operations). The re-operation rate was 25 %, including 2 patients (4 operations) for hematuria, 4 patients for abdominal hemorrhage, 2 patients (3 operations) for abdominal infection, 1 patient for pancreatic venous thrombosis, 1 patient for anastomotic leakage, and 1 patient for pancreatic fistula. Conclusion Although simultaneous pancreas-kidney transplantation provides a successful and effective treatment for diabetics with endstage renal disease, surgical complication is still affecting the pancreas and kidney grafts after transplantation.     

Severe pancreaticoduodenal trauma: review of a series of 30 patients]

Retrospective study of a series of 30 patients (mean age: 25.5 years), including 8 children with severe duodenopancreatic trauma, treated over a period of 15 years. This series consisted of 14 cases of duodenal perforation, 3 cases of duodenal haematoma, 11 cases of isolated pancreatic lesions (including 5 isthmic ruptures) and 2 cases of associated duodenal and pancreatic lesions. Injuries were due to road accidents in 60% of cases. Eight patients were considered to have multiple injuries. Twelve patients required emergency surgery. Eighteen were observed in a surgical unit. Two duodenal haematomas were operated. Duodenal perforations were operated urgently in 8 cases and electively in 6 cases. The surgical procedure consisted of simple suture (n = 3), suture combined with diversion (n = 7), or resection-anastomosis (n = 4). Five patients with pancreatic contusion were operated, in a context of acute pancreatitis in four cases and for associated lesions in one case. Isthmic ruptures were treated by left pancreatic resection. This was a rare lesion (1.8 to 9% of organ lesions). Duodenal haematomas justify first-line medical treatment, while duodenal perforations must be operated. The presence of a lesion of the pancreatic duct frequently justifies pancreatic resection.     

外伤性十二指肠损伤的诊断与治疗

目的 探讨提高十二指肠损伤的早期诊断率和合适的治疗方法。方法 回顾性分析４０例十二指肠损伤患者的临床资料。结果 ４０例中３２例（８０％）为严重多发伤。致伤原因以挤压伤,撞击伤为主,占８２．５％。全部经手术治疗：行十二指肠修补术２４例,空肠十二指肠Ｒｏｕｘ－ｅｎ－Ｙ吻合术８例,十二指肠改良憩室化手术６例,改良憩室化再简化手术２例,治愈３５例,死亡５例,死亡原因为多脏器损伤,创伤性休克及十二指肠瘘,感     

十二指肠损伤诊治的经验和教训

目的　提高十二指肠损伤的早期诊断率和选择合适的治疗方法。方法　总结１９８３ 年１ 月至１９９８年１２ 月收治的１７ 例十二指肠损伤患者的临床资料。多为严重多发伤,致伤原因以车祸伤为主,全部经手术治疗。行十二指肠修补术１１ 例,十二指肠改良憩室化手术４ 例,改良憩室化再简化术和十二指肠ＲｏｕｘｅｎＹ 吻合术各１ 例。结果　治愈１４ 例,死亡３ 例。致死原因为十二指肠瘘和多器官功能障碍综合征。十二指肠瘘和腹腔脓肿是主要的并发症。结论　十二指肠损伤早期诊断和及时手术处理是非常重要的。改良十二指肠憩室化和十二指肠修补术是比较实用的手术方法。     

改良十二指肠憩室化手术在严重十二指肠损伤中的应用

目的探讨一种实用、简单、有效、安全的治疗十二指肠损伤的方法。方法回顾性分析我院2000年1月-2007年12月收治的十二指肠损伤18例的临床资料。结果本组治愈16例,死亡2例,治愈率为89％。死亡原因为十二指肠瘘、感染性休克及多器官功能衰竭。十二指肠瘘、腹腔脓肿和肠梗阻是其主要的并发症。结论此简化的改良十二指肠憩室化手术是一种较实用、安全的手术方法。