|本期目录/Table of Contents|

[1]孔庆军,季锡清,盛新华.胰腺外伤处理原则及防治对策[J].医学研究与战创伤救治(原医学研究生学报),2008,10(05):352.
　KONG Qing-jun,JI Xi-qing,SHENG Xin-hua.The principle and strategies of surgical treatment of pancreatic trauma[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2008,10(05):352.
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胰腺外伤处理原则及防治对策()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第10卷
期数:
2008年05期
页码:
352
栏目:
出版日期:
2008-09-20

文章信息/Info

Title:
The principle and strategies of surgical treatment of pancreatic trauma
文章编号:
1672-271X(2008)05-0352-04
作者:
孔庆军1; 季锡清2; 盛新华2
1．南京军区南京总医院，江苏南京 210002；2.第二军医大学长征医院，上海 200003
Author(s):
KONG Qing-jun1; JI Xi-qing2; SHENG Xin-hua2
General Hospital of Nanjing Military Command, Nanjing 210002，Jiangsu，China; 2.Changzheng Hospital, the Second Military Medical University, Shanghai 200003,China
关键词:
胰腺; 创伤和损伤; 外科手术
Keywords:
Pancreas;  Wounds and injures;  Surgical procedures
分类号:
R657.5
DOI:
-
文献标志码:
A
摘要:
目的 分析胰腺外伤患者的临床表现及处理方法，总结胰腺外伤的外科治疗原则及对策。方法 回顾性分析47例胰腺外伤病例的临床资料。结果 CT检查对胰腺损伤确诊率可高达100%，本组患者均行手术治疗，其中40例患者治愈，术后早期死亡3例，为多器官合并伤；后期死亡4例，死于严重的胰腺坏死、胰瘘及感染所致的多器官功能衰竭，病死率14.9%。25例Ⅰ~Ⅱ度胰腺损伤均行清创加封闭式负压吸引引流。14例Ⅲ度胰腺损伤行远端胰腺切除、近端缝扎、胰床置闭式负压吸引，6例Ⅳ度、2例Ⅴ度胰腺损伤行幽门旷置术、胆管引流、空肠造瘘及完全引流手术。并发症有胰瘘7例、腹腔脓肿3例、胰腺假性囊肿2例。胰瘘者经保守治疗痊愈。胰腺假性囊肿患者经囊肿空肠内引流术而愈。腹腔脓肿经再次手术引流后痊愈。结论 胰腺闭合性损伤临床表现隐匿，CT可明显提高术前确诊率，腹部外伤患者的剖腹探查术中仍必须重视胰腺检查，充分闭式负压吸引引流及适当的手术方式是提高胰腺外伤患者生存率的关键。
Abstract:
Objective To analyze the clinical data of patients with pancreatic trauma, and to summarize the principle and strategies of surgical treatment of pancreatic trauma.Methods The clinical data of 47 cases with pancreatic trauma were analyzed retrospectively. Results The results showed that all the 47 cases could be diagnosed by CT scan. Emergency operations were performed for all the patients, and forty patients were cured. 3 patients died early because of multiple associated injuries and 4 patients died of multiple organ failure caused by severe necrosis of pancreas, pancreatic fistula and infection later stage. The total mortality rate was 14.9%. The debridement and closed suction drainage were received for 25 patients with gradeⅠandⅡ injures. The distal pancreatectomy and closed suction drainage near the pancreatic bed were performed in 14 patients with grade Ⅲ injury. The distal pancreatectomy, distal Roux-en-Y pancreaticojejunostomy, pancreatic duct repair and pyloric exclusion were performed in 6 patients with grade Ⅳ injury. 2 patient with grade Ⅴ received pyloric exclusion, bile duct T-tube drainage, jejunum stoma and totally drainage. The complications were occurred in 7 cases with pancreatic fistula, 3 cases with abdominal abscess and 2 cases with pancreatic pseudocyst. The pancreatic fistula was cured by conservative treatment. The abdominal abscess was cured by second operation. The pancreatic pseudocyst was cured by cyst-jejunostomy.Conclusion CT scan is the most helpful means to diagnose pancreatic trauma. Surgeons must attach importance to check-up pancreas in the laparotomy of abdominal trauma. The adequate drainage and proper surgical management can improve the effect of treatment.

参考文献/References:

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2013-11-22