胰腺损伤25例临床诊治分析

摘要

目的 总结胰腺损伤的临床诊治经验.方法 回顾性分析2000年1月-2015年12月上海交通大 学附属第九人民医院收治的胰腺损伤患者25例的临床资料,男17例,女8例,年龄19 ～68岁.按美国创伤外科学会(AAST)对胰腺损伤分级,Ⅰ级3例,Ⅱ级15例,Ⅲ级4例,Ⅳ级2例,Ⅴ级1例.结果 25例患者中16例为腹部闭合性损伤,9例为腹部开放性损伤;保守治疗11例,未行胰腺手术1例,行胰腺手术13例(其中6例行远端胰腺切除,6例行修补术,1例行清创填塞术);7例发生胰腺手术相关并发症;死亡3例,失访3例,术后随访19例,发生糖尿病4例.结论 创伤性胰腺损伤病情复杂危重,针对性的治疗方案和合理的手术方式是治疗胰腺损伤的重要环节.对全身及局部情况危重的患者应遵循损伤控制外科(DCS)的原则.创伤后胰腺的功能取决于残留胰腺的多少和健康度.%Objective To summarize the clinical experience in diagnosis and treatment of pancreatic injury.Methods The clinical data of 25 cases of pancreatic injury treated surgically from January 2000 to December 2015 in Department of General Surgery,Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University were analyzed.All the cases were graded according to American Association for the Surgery of Trauma-Organ Injury Scale.Results 16 cases were abdominal closed injury,9 cases were open abdominal injury,13 cases underwent surgeries,including distal pancreatectomy in 6 cases,pancreatic repair in 6 cases,debridement and packing in 1 case.3 patients died after operations.7 cases suffered pancreatic postoperative complications.19 cases were followed up,and 4 cases developed diabetes.Conclusion Traumatic pancreatic injury is complicated and critical.Reasonable treatment and surgical procedure are important in the treatment of pancreatic injury.The principle of damage control surgery (DCS) should be followed in the patients with systemic and local critical conditions.The function of the pancreas after trauma depends on the amount and the healthcondition of residual pancreas.