胰腺损伤诊治的反思

目的胰腺损伤较少见,诊治较难,反思24例的经验,以期改进。方法总结19例闭合伤、2例开放伤、3例医源性伤的诊治情况,评估对不同损伤用各种手术(引流、修补、切除病变、胃或十二指肠转流等)治疗的结果。结果21例外伤性胰伤中,12例(57.1)和9例(42.9)分别伴腹内和腹外损伤。19例闭合性伤中仅4例(21.1%)籍CT临床确诊、外伤性伤17例(闭合性15、开放性2)中16例(94.1%)术中诊出,1例(5.9%)手术漏诊而需再手术;医源性损伤3例估计可能发生于原手术中。7例(70.8%)术中并发症,包括休克、腹腔感染、MOF、胰瘘、假性囊肿等,其中3例需再手术治疗。治愈21例(87.5%),3例(12.5%)死亡,与诊断延误,术式不当有关,术后并发症为直接原因。结论本病损伤伴发伤多,误漏诊较多,手术治疗方式繁多,应按多因素合理选择,术后并发症率和病死率较高。诊治水平的提高,尚需从多方面努力。

INTROSPECTION OF DIAGOSIS AND TREATMENT OF PANCREATIC INJURIES

Objective Pancreatic injury is less common,and its diagnosis and treatment quite difficult.The authors reviewed their experiences in 24 case for expecting henceforth improving the management of this injury. Methods To sum up the experiences in diagnosing and treating 19 cases with blunt traumas,2 penetrating and 6 iatrogenic ones,and appraise the curative effects of various operative procedures such as simple drainage,repairing wounds,resecting lesions and gastric or duodenal bypass for different injuries.Results Among 21 cases with traumatic injurics intra-abdominal associated injuries and extra-abdominal ones happened in 12(57.1) and 9 cases(42.9) respectively.In these 19 cases with blunt traumas there were only 4(22.7%) clinically diagnosed with CT;16 in 17 cases(lunt injured 15,penetrating injured 2) traumatic injuries only intraoperatively affirmatively diagnosed and 1(5.9%)missed,needing reoperation.3 cases with iatrogemic ones might estimatively happen in the primary operations.Postoperative complications such as schock,abdominal infection,MOF,pancreatic fisfula and pseudocyst happened in 17 cases(70.8%).3 among them further operated on for their complications.21 cases(87.5%) cured.3 cases(12.5%) died due to delayed diagnosis and improper operations performed,directly caused by some postoperative complications.Conclusion Associated injures frequently happened in this injury.Misdiagnosis more frequently resulted in these injuries.The operation for this kind of injury are numerous and the performed one should be properly choosed according to numerous factors as the timing of operation,the general status and local damages of the injured,whether or not with associated traumas,etc.The incidences of postoperative complications and deaths are both high.For better achievements in diagnosis and treatment great efforts should be made in related respects.