闭合性腹部伤致胰腺断裂的临床研究

目的分析闭合性腹部伤致胰腺断裂患者的临床表现、辅助检查及治疗方式，总结诊治体会，加深对此类损伤的认识，探讨闭合性腹部伤致胰腺断裂的诊治方案。方法本院收治43例闭合性腹部伤致胰腺断裂患者，其中有胰腺横断、主胰管断裂及胰头或胰体尾挫伤合并十二指肠、脾、小肠多发性破裂等。根据胰腺损伤的部位及严重程度而选择不同的手术方式。结果本组患者均行手术治疗。其中远端胰并脾切除术22例，远端胰腺空肠吻合术8例，胰腺阶段性切除术6例，Berne(十二指肠憩室化手术）手术5例，胰头切除术2例。并发胰瘘3例，严重腹腔感染2例，消化道大出血1例，切口裂开1例。43例患者经救治均痊愈出院。术前血、尿淀粉酶检查对胰腺损伤的诊断符合率可高达95％，但特异性低；CT检查对胰腺损伤的诊断符合率为90％；B超检查对胰腺损伤的诊断符合率为45％。结论闭合性腹部伤致胰腺断裂的临床表现隐匿，术前血、尿淀粉酶检查，CT及B超检查可明显提高术前确诊率。其手术方式要根据胰腺损伤的部位和严重程度，以及合并其他脏器损伤的情况决定。

Clinical research of the diagnosis and treatment of pancreatic rupture caused by dosed abdominal trauma

Objective To analysis the clinical situation, assist determination and therapy maniers of patients with pancreatic rupture caused by closed abdominal trauma. To summarize the comprehension of diagnosis and treatment in order to deepen the noesis of the disease. And to explore the better ways of diagnosis and treatment. Methods There were 43 cases of pancreatic rupture caused by closed abdominal trauma, including pancreatic transaction, pancreatic duct rupture and head or body of pancreatic trauma united the injury of duodenum, lien and small intestine. We chose different operation according to the locus and severity of the injury on pancreas. Results Emergency operations were performed for all the patients. Among them, distal part of pancreas were removed combined splenectomy in 22 cases; pancreaticojejunostomy in 8 cases; pancreatic staged ectomy in 6 cases; pyloric exclusion operations in 5 cases and head of pancreas ectomy in 2 cases. There were 3 cases of pancreatic fistula, 2 case of severe abdominal cavity infection, l case of digestive tract massive hemorrhage and 1 case of disruption of wound after the operation. All the 43 patients fully recovered and discharged. Conclusions The clinical situation of pancreatic rupture caused by closed abdominal trauma is concealing. The detect of amylase in blood and urine, CT scan and B ultrasound test before operation can significantly increase the final diagnosis rate. And we should choose reasonable operation manier according to the locus and severity of the injury on pancreas and the condition of other injured organ in abdominal cavity.