胰腺损伤的诊治策略探讨

目的探讨胰腺损伤的诊断及治疗对策。方法回顾性分析45例胰腺损伤病例资料。结果17例闭合性胰腺损伤和6例开放性胰腺损伤属于腹部多脏器伤，表现腹腔出血、腹膜炎。5例腹部单纯性胰腺钝伤呈现肠梗阻3例、腹部肿决1例、胰腺炎1例。17例医源性胰腺损伤出现胰腺出血、胰瘘。胰腺损伤术前早期诊断困难，术中依据胰腺损伤的严重程度，采取不同的处理方法。治愈43例，死亡2例。结论手术探查可确诊开放性胰腺损伤和有腹部症状、CT可疑的闭合性胰腺损伤。医源性胰腺损伤重在预防。根据病人全身情况和胰腺损伤分级决定合适的术式是降低死亡率、减少并发症的关键。

Discussion on strategy of diagnosis and treatment for pancreatic injury

Objective To explore the strategy of diagnosis and treatment for pancreatic injury.Methods The clinical data of 45 patients with pancreatic injury were retrospectively analyzed.Results Intraperitoneal hemorrhage and peritonitis were main symptoms in open pancreatic trauma(6 cases) and closed pancreatic trauma(17 cases) combined with other abdominal organ trauma.Simple blunt pancreatic trauma(5 cases) showed bowel obstruction(3 cases),intraperitoneal mass(1 case) and pancreatitis(1 case).Iatrogenic pancreatic trauma(17 cases) showed pancreatic fistula and pancreatic hematoma.Early diagnosis of pancreatic trauma is difficult. Several methods of diagnosis were used to evaluate the degree of pancreatic injuries,and different surgical procedures were performed to treat the patients.Among them,43 cases were cured,2 cases died.Conclusion Open and closed pancreatic injury combined with obvious symptoms or suspicion on CT can be established during laparotomy exploration.To protect carefully pancreas is of great importance for iatrogenic pancreatic injury during epigastric operation.Appropriate surgical management is the key to reduce the complication and mortality based on patient's condition and the classification of pancreatic trauma.