中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2010年
5期
315-317
,共3页
林贤超%黄鹤光%陈燕昌%陆逢春%林荣贵
林賢超%黃鶴光%陳燕昌%陸逢春%林榮貴
림현초%황학광%진연창%륙봉춘%림영귀
胰腺%创伤和损伤%闭合性%个体化治疗
胰腺%創傷和損傷%閉閤性%箇體化治療
이선%창상화손상%폐합성%개체화치료
Pancreas%Wounds and injuries%Closed%Individual treatment
目的 进一步提高闭合性胰腺损伤救治水平,尽可能地保留胰腺内外分泌功能.方法 回顾20例闭合性胰腺损伤病例的临床资料,分析总结该类损伤的治疗措施.结果 20例患者均有明确的闭合性上腹部外伤病史,行胰腺CT增强扫描,均符合诊断.根据入院时一般情况、腹部体征、主胰管损伤情况采取急诊手术或非手术治疗.10例因严重腹膜炎及明确的主胰管断裂而行急诊手术,其中胰尾切除1例,单纯外引流6例,断裂胰管外引流、二期手术3例;10例临床情况稳定、无明确主胰管损伤者,急性期在密切观察下行非手术治疗,其中3例治愈,7例延期手术,包括因胰头血肿扩大行胰十二指肠切除1例,胰腺假性囊肿内引流3例,胰腺假性囊肿外引流3例.20例患者均全部治愈.结论 闭合性胰腺损伤采用保存胰腺的个体化治疗方案,可提高手术安全性,并可避免胰腺切除,最大限度地保留胰腺内外分泌功能.
目的 進一步提高閉閤性胰腺損傷救治水平,儘可能地保留胰腺內外分泌功能.方法 迴顧20例閉閤性胰腺損傷病例的臨床資料,分析總結該類損傷的治療措施.結果 20例患者均有明確的閉閤性上腹部外傷病史,行胰腺CT增彊掃描,均符閤診斷.根據入院時一般情況、腹部體徵、主胰管損傷情況採取急診手術或非手術治療.10例因嚴重腹膜炎及明確的主胰管斷裂而行急診手術,其中胰尾切除1例,單純外引流6例,斷裂胰管外引流、二期手術3例;10例臨床情況穩定、無明確主胰管損傷者,急性期在密切觀察下行非手術治療,其中3例治愈,7例延期手術,包括因胰頭血腫擴大行胰十二指腸切除1例,胰腺假性囊腫內引流3例,胰腺假性囊腫外引流3例.20例患者均全部治愈.結論 閉閤性胰腺損傷採用保存胰腺的箇體化治療方案,可提高手術安全性,併可避免胰腺切除,最大限度地保留胰腺內外分泌功能.
목적 진일보제고폐합성이선손상구치수평,진가능지보류이선내외분비공능.방법 회고20례폐합성이선손상병례적림상자료,분석총결해류손상적치료조시.결과 20례환자균유명학적폐합성상복부외상병사,행이선CT증강소묘,균부합진단.근거입원시일반정황、복부체정、주이관손상정황채취급진수술혹비수술치료.10례인엄중복막염급명학적주이관단렬이행급진수술,기중이미절제1례,단순외인류6례,단렬이관외인류、이기수술3례;10례림상정황은정、무명학주이관손상자,급성기재밀절관찰하행비수술치료,기중3례치유,7례연기수술,포괄인이두혈종확대행이십이지장절제1례,이선가성낭종내인류3례,이선가성낭종외인류3례.20례환자균전부치유.결론 폐합성이선손상채용보존이선적개체화치료방안,가제고수술안전성,병가피면이선절제,최대한도지보류이선내외분비공능.
Objective To improve the management of blunt pancreatic trauma, and to explore the strategy of preserving the pancreatic endocrine and exocrine function to the full extent. Methods 20 cases of blunt pancreatic trauma were reviewed and analyzed retrospectively. The methods of operative treatment were analysed. Results All patients were cured. Depending on the general condition, abnomial signs and main pancreatic duct(MPD) injuries at the time of admission, patients received immediate operation or nonoperative treatment. Because of severe peritonitis and demonstrated MPD injury, 10 patients underwent immediate operations, including simple drainage in 6 cases, distal pancreatectomy in 1 patient, external drainage of the injured pancreatic duct for the second operation in 3 cases. Without the demonstrated MPD injury or clinical deterioration, 10 patients received nonoperative treatment under strict observation initially. 3 patients completed the nonoperative course and 7 patients underwent delayed operations, including Roux-en-Y pancreatic cyst-jejunostomy in 3 cases, external drainage of pseudocyst in e cases, pancreaticoduodenectomy in 1 patient because of the expanded hematoma in pancreatic head. Conclusions Blunt pancreatic trauma could receive individual pancreas-preserving treatment, which could improve the operational safety, avoid the resection of pancreas and preserve the pancreatic endocrine and exocrine function to the full extent.
