严重胰腺损伤的诊治

目的 探讨严重胰腺损伤的诊断与外科治疗方法。方法 回顾分析我院近20年32例3～5级胰腺损伤的临床资料。结果 术前腹腔穿刺液淀粉酶升高占50％，血淀粉酶升高者占60％(12／20)。B超检查10例，3例提示诊断。CT检查8例，3例提示诊断。术前诊断胰腺损伤仅10例。32例均手术治疗，术中证实胰腺损伤属3级者20例，4级10例，5级2例。治愈25例，死亡7例，死亡率21．9％。并发症有腹腔脓肿、胰瘘、胰腺假性囊肿等。结论 严重胰腺损伤合并伤多，术前诊断困难，术后并发症多和死亡率高。早期确诊、术中仔细探查，合理的手术方式是关键。术中B超和术中造影有助于诊断。生长激素和生长抑素的应用有较好的治疗效果。

Diagnosis and treatment of severe pancreatic trauma

Objective To evaluate the diagnosis and treatment of severe pancreatic trauma(SPT). Methods The clinical data of 32 patients with transected pancreatic trauma(grade 3-5) admitted into our hospital in recent 20 years were retrospectively analyzed. Results Twenty patients were in grade 3, 10 in grade 4,and 2 in grade 5. Operations were performed on all 32 patients. Twenty-five recovered, and 7 died. The mortality was 21.9%.Before the operation, peritoneal lavage fluid amylase rose in 10 patients(50%),and serum amylase rose in 12 patients(60%). Imaging examination included ultrasonography in 10 (diagnosed in 3),and CT in 8 (diagnosed in 3). Diagnosis was established only in 10 patients before the operation. Complications included fistula, abscess and pseudocyst. Conclusions Incidence of associated trauma is high. The preoperative diagnosis of pancreatic trauma is difficult. The rates of morbidity and mortality are high. Early diagnosis, careful exploration and proper surgery are very important. Intraoperative pancreatography or ultrasonographic scanning is useful in diagnosis. Somatostatin and human growth hormone are useful in the treatment.