胰腺损伤的诊断与手术选择

目的　探讨胰腺损伤的诊断及合理的手术方式。方法　对 2 3例胰腺损伤患者的临床资料进行回顾性分析。结果　术前确诊 5例 ,其余 18例术中确诊。行单纯外引流 8例 ,胰头侧缝合加胰尾脾切除 6例 ,胰头侧缝合 ,胰体尾侧断端与空肠吻合 3例 ,胰腺次全切除 1例 ,十二指肠憩室化 5例。发生胰瘘 3例 ,腹腔内出血 1例 ,腹腔内感染 1例 ,胰腺内分泌功能低下 1例 ,死亡 5例。结论　术前确诊胰腺损伤较为困难 ,多需经术中探查确诊。根据胰腺损伤的部位和损伤程度以及伤者的全身状态 ,选择恰当的手术方式 ,可有效地减少其并发症 ,降低死亡率。

Diagnosis and surgical treatment of pancreatic injuries

Objective To explore diagnosis and operative treatment of pancreatic injury.?Methods Clinical data of 23 patients of pancreatic trauma from March 1994 to April 1999 were reviewed.?Results Five patents were diagnosed before operation and the other 18 cases were diagnosed during operation. Simple external drainage were made in 8 cases,proximal closure of pancreas plus splenectomy in 6 cases,proximal closure of pancreas and distal pancreaticojejunostomy in 3 cases,subtotal pancreatectomy in 1 case, duodeno diverticularzation in 5 cases. Fistula developed in 3 cases, intraperitoneal hemorrhage in 1 case,intraperitional infection in 1 case,hypo insulinism in 1 case.?Conclusion It is diffcult to diagnose pancretic injury before operation. For most cases,diagnosis can only be established during exploration. Appropriate operation could reduce the morbidity of complications and mortality of pancreatic injuries .