腹腔镜中胰腺损伤的处理研究

目的：分析腹腔镜手术中胰腺损伤的原因，总结胰腺损伤的处理方法。方法：2008年3月-2012年6月共实施腹腔镜手术498例，胰腺损伤20例，发生率4.0%。结果：术后第2d后血清胰蛋白酶平均（648±235.1）U，尿液胰蛋白酶平均（1278±369）U，引流液胰蛋白酶平均（1368±428）U，患者生命体征平稳。引流管留置（13.5±2.9）d。3个月后复诊，血清胰蛋白酶恢复正常，B 超或 CT 显示胰腺及周围未见异常。结论：掌握胰腺与周围脏器解剖位置关系是避免胰腺损伤的重要前提。一旦损伤胰腺，术野清晰时可在腹腔镜下进行常规外科处理，严重者需转为开腹手术，合并胰管损伤可考虑endo-GIA夹闭断裂胰腺。

Treatment research on pancreas injury in laparoscopic operation

Objective： To analyze causes of pancreas injury in laparoscopic operation and sum up solutions of pancreas injury. Methods：498 cases of laparoscopic operation were conducted from March in 2008 to June in 2012, including 20 cases of pancreas injury, and the incidence rate of pancreas injury was 4.0%. Results： 2 days after operation, the average level of trypsase in serum was（648＆#177;235.1）U, trypsase in urine was（1278＆#177;369）U, trypsase in draining liquid was（1368＆#177;428）U, and vital sign was steady. Drainage tube persisted （13.5＆#177;2.9）d, and patients had subsequent visit 3 months later, trypsase in serum was normal, type-B ultrasonic and computer tomography （CT） did not show any abnormality of pancreas and surrounding. Conclusion：It is essential to master anatomical positions of pancreas and its surrounding organs to avoid pancreas injury. Once pancreas is injured, it can be treated by surgical technique for clear field of view;laparotomy can be operated for severe cases, and endo-GIA occlusion can be applied for pancreas injury.