12例胰腺横断性损伤诊治分析

目的：分析胰腺横断性损伤的临床特点，以及诊断治疗的经验。方法回顾性分析山西医科大学第二临床医院自2002年3月～2013年11月收治的12例胰腺横断性损伤患者的临床资料、诊断、治疗方法。结果本组病例术前诊断为胰腺断裂者7例，诊断率为58.3%。本组死亡1例，术后并发胰瘘7例，其中并发腹腔脓肿4例。术后并发假性囊肿3例。7例胰瘘患者中6例经非手术治疗治愈，1例行瘘管空肠吻合治愈。胰腺假性囊肿患者中1例经保守治疗出院，1例行囊肿外引流痊愈，1例行囊肿胃一期内外引流术治愈。结论胰腺横断伤术前行CT检查诊断率较高，但及时的确诊仍依赖于及早行剖腹探查。胰腺横断性损伤可尝试保守治疗，但并发症发生率高；对于胰腺严重横断伤的患者可以行损伤控制性手术方案，避免患者早期死亡，虽然术后并发生发生率高，保证引流通畅的前提下，可经围手术期综合治疗方案获得治愈。

An analysis of diagnosis and treatment of 12 cases of traumatic transection of pancreas

Objective To analyse the clinical characteristics of traumatic transection of pancreas and experience of diagnosis and treatment. Methods Clinical data and methods of diagnosis and treatment of 12 patients with traumatic transection of pancreas who were admitted to the Shanxi Medical University Second Hospital from March 2002 to November 2013 were retrospectively analysed. Results 7 patients were diagnosed as pancreatic rupture before the surgery in the group, with the diagnostic rate of 58.3%. 1 patient died in the group, and 7 patients were complicated with pancreatic fistula after the surgery, among whom 4 patients were complicated with abdominal abscess. 3 patients were complicated with pseudocyst after the surgery. 6 of 7 patients with pancreatic fistula were cured with non-surgical treatment, and 1 patient was cured by fistulo-jejunostomy. 1 patient among the patients with pancreatic pseudocyst discharged from the hospital by conservative treatment, 1 patient was cured by external pseudocyst drainage, and 1 patient was cured by internal and external pseudocyst drainage. Conclusion The surgery of traumatic transection of pancreas has a higher diagnostic rate after CT examination, but timely diagnosis is highly dependent on abdominal laparotomy in an early basis. Traumatic transection of pancreas can be treated by conservative treatment, but the incidence of complications is high;patients with severe traumatic transection of pancreas are better to receive damage control surgery so as to avoid a premature death of patients. Despite the fact that the incidence of complications is high after the surgery, the patients can be cured via perioperative comprehensive treatment on the condition of unobstructed drainage.