闭合性胰腺损伤21例的诊治分析

目的 探讨闭合性胰腺损伤的诊断治疗方法.方法 对近5年来收治并行手术治疗的21例闭合性胰腺损伤的临床资料进行回顾性分析.结果 21例患者中3例为单纯胰腺损伤,18例为合并腹腔内其他脏器损伤.根据胰腺损伤分级标准,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级损伤的例数分别为4、7、5、3、2例,仅有9例患者术前通过CT获得诊断,11例术中探查确诊,1例第一次手术时漏诊.手术方式采用局部引流或清创缝合后引流8例,连同脾脏的胰体尾切除5例,保留脾脏的胰体尾切除3例,近侧断端封闭、远侧断端胰腺空肠吻合3例,十二指肠憩室化加局部引流1例,胰十二指肠切除1例.12例手术后完全治愈,5例术后并发胰瘘,2例形成假性囊肿,均经引流而治愈,死亡2例.结论 胰腺闭合性损伤术前误诊率高,应尽可能采用CT检查以明确诊断;术中需仔细探查,选择简单、有效的手术方式,保证引流通畅是治疗成功的关键.

Diagnosis and treatment of 21 blunt pancreatic trauma patients

Objective To investigate the diagnosis and treatment of the blunt pancreatic injury.Methods The clinical data of 21 blunt pancreatic trauma patients admitted to our hospital in the past 5 years were analyzed retrospectively.Results 3 of 21 patients were simple blunt pancreatic injury, while the other 18 patients were complicated with other abdominal organs injuries.According to the grading criteria, the number of Ⅰ , Ⅱ, Ⅲ, Ⅳ, Ⅴ grade injury were 4, 7, 5, 3 and 2 cases, respectively, and only 9 patients were diagnosed by CT before operation, and the diagnosis was confirmed during the operation in 11 patients, and 1 was miediagnosed in the first operation.Single drainage or debridement and drainage were performed in 8 cases and distal pancreatectomy with and without spleen were performed in 5 and 3 cases, respectively, and 3patients received pancreaticojejunostomy, 1 received Whipple operation, the other 1 case underwent duodenorrhahy and diverticulation.The mortality rate was 9.5% (2/21), and the complications of pancreatic pseudocyst and fistula developed in 2 (9.5%, 2/21 ) and 5 (23.8%, 5/21 ) cases respectively, and they were cured by drainage, while the other 12 were cured completely.Conclusions The preoperative misdiagnosis rate of pancreatic trauma is high;CT scan should be used to confirm the diagnosis.Careful pancreatic exploration is mandatory and simple and effective surgical procedures with effective drainage is important for treatment success.