27例胰腺外伤诊治的临床分析

目的 探讨胰腺外伤的诊治经验。方法 回顾性分析我科收治的27例胰腺外伤患者的临床诊断及治疗效果。结果 27例患者均行手术治疗。死亡2例（死亡率7．4％）。1例术中死亡，1例术后死亡；治愈25例，治愈率92．6％（25／27）。围术期发生并发症8例，并发症发生率29．6％，其中胰瘘4例，胰岛功能不足1例，胰腺囊肿1例，胆汁瘘及腹腔感染各1例，均经处理后治愈。27例中17例行胰腺被膜缝合止血，清创修补，胰周双套管冲洗及引流，2例行胰体尾部切除加脾切除，3例行保留脾脏的胰体尾切除，近端缝扎，胰床置外引流术，1例行损伤远侧胰腺加脾切除，胰床置引流，1例行胰腺近端缝扎，远侧行胰空肠Roux—en—Y吻合术，1例行十二指肠憩室化术，1例行胰十二指肠切除，1例未能完成手术。结论 提示早期诊断、术中仔细探查、合理的手术方式是治疗胰腺损伤成功的关键。

Diagnosis and treatment of pancreatic injury

Objective To investigate the diagnosis and treatment of pancreatic injury.Methods A retrospective analysis was made on the clinical date of 27 cases treated in our hospital.Results Twenty-seven cases received operation.Two cases died(the mortality was 7.4%),1 case died in operation,1 case died after operation;25 cases cured(the cure rate was 92.6%).The perioperative complications occurred in 8 cases,the complication rate was 29.6%,among them 4 cases were pancreatic fistula,1 case was islets of langerhans deficiency,1 case was pancreatic cyst,1 case was biliary fistula, 1 case was abdominal infection.All patients were cured.Seventeen cases underment pancreas capsule suture for stanching bleeding,using double ducts to drainage and flush,2 cases underwent resection of spleen and pancreas body and tail,3 cases underwent spleen preserving resection of the body and tail of the pancreas,proximal pancreatic seam and external drainage,1 case underwent distal pancreatic and spleen ectomy and external drainage,1 case roximal pancreatic seam,distal Roux-en-Y pancreaticojejunostomy,1 case underwent duodenectomyduodeno diverticularization resection,1 case underwent pancreatoduodenectomy,1 case did not accomplish operation.Conclusion Early diagnosis,careful exploration and proper surgery are very important in pancreatic injury.