医源性胰损伤的防治对策

目的：探讨医源性胰腺损伤的防治对策。方法：回顾总结1990～2002年发生的医源性胰腺损伤38例，分析其产生原因，治疗经过，提出防治对策。结果：38例中手术损伤21例，ERCP损伤13例，经T管胆总管造影损伤2例，药物性损伤2例。术中胰腺裂伤缝呈局部引流6例，胰体尾部分切除2例，其中1例行保留肿脾脏的胰体尾部分切除。胰头近侧断端缝闭，远端与空肠行Roux—en—y吻合1例。囊肿穿刺抽吸加无水酒精注射1例，囊肿胃吻合2例，囊肿空肠Roux—en—y吻合3例。家脓肿引流3例，腹腔镜腹腔冲洗置管引流1例。单纯保守治疗19例，治愈37例，死亡1例。结论：通过个体的措施，大多数医源性胰腺损伤是可以预防的。一旦发生胰腺损伤，应采取相应的术式及通畅引流，积极治疗并发症。

THE COUNTERMEASURES ABOUT PREVENTIONS AND TREATMENTS ON THE MEDICAL INJURES TO THE PANCREASES

Objective:Review and draw lessons from the medical injures to the pancreas .afford preventions and treatments on how to deal with them. Methods:By retrospective surveying the medical injures to the pancreas from 1990 to 2002, there have been existed 38 injures. We can provide preventions and treatments after having analyzed the reasons caused them. Results:Out of the 38 cases,21 were injured in operations , 13 were injured by ERCP.2 were injured by cholangiography , and 2 by drugs. In the operation , 6 cases had rhapice of pancreatic lacerated wound and partially put draft tube,and 2 cases had partially removal of tail pancreases,among which 1 was reserved the spleen. There was 1 case that the proximative cephalpancrease was sewed up and the far - end was took Roux -en- y anastomosis to jejunum. 1 was kystis nyxis and pure alcohol injection.2 were kystis and stomach anastomosics . 3 were kystics and jejunum Roux - en - y anastomosis. 3 were put dratf tube of apostasies. 1 was washed by laparo-scope and put draft tube. In these cases , 19 were adopted conservative treatment ,and 37 were cured while 1 died. Conclusions: By means of taking the concrete measures, the medical injures to the pancreases can be prevented. Once the injures take place, they should be settled as early as possible and adopted measures according to different types , and then ensured the draft tube unobstructed as well as the complication disposed reliably.