严重胰腺损伤的诊断与手术策略

目的 探讨胰腺损伤的诊断，提高严重胰腺损伤的救治水平。方法 对1986年1月－1998年12月我院收治的14例胰腺横断及胰头毁损患者的临床资料进行回顾性分析。结果 本组胰体尾横断5例、胰颈部横断6例、胰头毁损3例，11例有腹内合并伤。术前诊断4例，开腹探查诊断9例，首次手术漏诊、再次开腹诊断1例。手术方式：远端胰腺切除5例，近端缝合加远端胰腺空肠吻合5例，胰头部切除加远端胰腺空肠吻合3例，单纯外引流1例。本组发生胰瘘5例，死亡3例。结论 早期诊断胰腺损伤仍有困难，多数需靠术中发现；根据胰腺损伤的部位和程度选择恰当的手术方式可有效地减少并发症、降低死亡率。

Diagnosis and surgical management for severe pancreatic injuries

Objective To explore the diagnosis and surgical management for severe injury of the pancreas. Method Fourteen patients with transected or derogated pancreatic trauma from January 1986 to December 1998 were reviewed. Result The mean age was 31 years.Injury was on the body and tail of the pancreas in 5 cases, on the neck in 6,and on the head in 3. Eleven patients suffered from compound injuries of the adjacent organs .Preoperative diagnosis was made in only 4 patients,diagnosis was achieved during first laparotomy in 9 patients ,and in second look in 1 patient.The operative procedure involved distal pancreatectomy in 5,proximal pancreatorrhaphy and distal pancreatojejunostomy in 5,head resection and distal pancreatojejunostomy in 3, and simple external drainage in 1.Fistula developed in 5 cases and perioperative mortality was 3/14.Conclusion Preoperative diagnosis for pancreas injury is difficult,and in most cases diagnosis can only be established during exploration.An appropriate operative procedure reduces the morbidity and mortality of pancreatic injuries.