重度胰腺外伤的诊断与治疗

摘要

Objective To investigate the diagnosis and surgical treatment of severe pancreatic trauma.Methods The clinical data of 22 patients with severe pancreatic trauma admitted during January 1990 and December 2009 was retrospectively analyzed.Results According to trauma gradings of American Society for Surgery of Trauma (AAST), there were 14 cases of grade Ⅲ, 6 cases of grade Ⅳ, and 2 cases of gradeⅤ.Serum amylase was higher than normal value in 7 cases; peritoneal puncture fluid showed amylase was significantly higher in 4 cases; 17 cases received bedside ultrasound B, but only 5 were diagnosed; 10 cases were diagnosed by CT and (or) MRCP examination.All patients underwent surgical treatment according to AAST, including emergency surgery in 14 cases, and elective surgery in 8 cases.3 cases developed postoperative pancreatic fistula complicated with intestinal fistula, and abdominal abscess in 2 cases respectively, and bleeding in 1 case.19 cases were cured and 3 patients died.The cure rate was 86.36％ , and the complication rate was 36.36％.Conclusion Laparotomy is the most reliable diagnostic method for pancreatic trauma, and timely and accurate processing and adequate drainage are the key factors to reduce complications and improve treatment success rate.%目的 探讨重度胰腺外伤的诊断与治疗方法.方法 对1990年1月～2009年12月收治的22例重度胰腺外伤的临床资料进行回顾性分析.结果 本组依据美国创伤外科协会(AAST)损伤分级:Ⅲ级14例,Ⅳ级6例,Ⅴ级2例.血淀粉酶增高7例;腹腔穿刺液淀粉酶明显增高4例;行床旁B超检查17例,明确诊断5例;经CT和(或)磁共振胰胆管造影(MRCP)检查明确诊断10例.均行手术治疗,其中急诊手术14例,择期手术8例.术后并发胰瘘3例,并发肠瘘、腹腔脓肿各2例,出血1例.本组治愈19例,死亡3例,治愈率86.36%,并发症发生率36.36%.结论 剖腹探查是胰腺外伤最可靠的诊断方法,及时准确的处理及充分引流是降低并发症、提高救治成功率的关键.