小儿胰腺损伤诊治分析

目的探讨小儿胰腺损伤临床特点及诊治方法。方法我院自2004年8月～2011年12月共收治胰腺损伤患儿13例,其中Ⅰ度胰腺损伤3例,Ⅱ度7例,Ⅲ度2例,Ⅳ度1例;淀粉酶升高4例。13例患儿均经病史、腹部查体、淀粉酶检测、B超及CT明确诊断,4例经手术探查证实。结果 3例Ⅰ度及6例Ⅱ度经非手术治疗;1例Ⅱ度行腹腔广泛引流;1例Ⅲ度胰腺损伤因膜膜炎行剖探查术,术中见腹腔中等量积液,胰腺中部断裂,胰管未断裂,行断裂修补,局部引流;1例Ⅲ度因形成胰腺假性囊肿行胰腺囊肿-空肠Roux-Y吻合术;1例Ⅳ度行胰腺断裂近端缝合、远端胰腺空肠Roux-Y吻合术。所有患儿均临床治愈。结论小儿胰腺损伤因其症状往往较为隐匿,诊断较为困难,了解胰腺损伤的机制及高度警戒心理有利于胰腺损伤的早期诊断及恰当治疗。胰淀粉酶及脂肪酶升高在胰腺损伤诊断中并不可靠;螺旋CT增强扫描检查应作为胰腺损伤首选检查方法;轻度胰腺损伤多可非手术治愈,重型胰腺损伤合并腹膜炎表现需行剖腹探查并相应处理。

Diagnosis and treatment of pancreatic trauma in children

Objective To investigate the clinical feature,diagnosis and treatment of pancreatic trauma in children.Methods Totally 13 patients suffered from pancreatic trauma were hospitalized from 2004 to 2011,3 cases of grade Ⅰtrauma,7 grade Ⅱtrauma,2 grade Ⅲ trauma and 1 grade Ⅳ trauma were diagnosed definitely according to history,body sign,serum amylase detection,B type ultrasound and CT examination,some were diagnosed by laparotomy.Four patients had elevated serum amylase.All the patiens were cured by operative or nonoperative mamagement.Results Three cases of grade Ⅰtrauma and six grade Ⅱtrauma were cured by nonoperative methods;One case of grade Ⅱtrauma was cured by simple drainage;One grade Ⅱtrauma was cured by simple drainage;One grade Ⅲ trauma was cured by suturing of the rupture and the other one case of grade Ⅲ trauma was cured by cysto-jejunostomy due to pancreatic pseudocyst;One grade Ⅳ trauma was cured by diatal pancreatico-jejunostomy.Conclusion There is a diagnosis challenge in pancreatic trauma,and high index of suspicion is helpful for early diagnosis and treatment.Elevations in serum amylase and lipase are not reliable to determine pancreatic trauma.Computed tomography is the initial choice in the setting of suspected pancreatic trauma.Most of grade Ⅰ and Ⅱ pancreatic injury can be cured without operation,while grade Ⅲ and Ⅳ pancreatic injury with peritonitis need early laparotomy.