CAJ | 학술논문

目的：分析腹腔镜手术中胰腺损伤的原因，总结胰腺损伤的处理方法。方法：2008年3月-2012年6月共实施腹腔镜手术498例，胰腺损伤20例，发生率4.0%。结果：术后第2d后血清胰蛋白酶平均（648±235.1）U，尿液胰蛋白酶平均（1278±369）U，引流液胰蛋白酶平均（1368±428）U，患者生命体征平稳。引流管留置（13.5±2.9）d。3个月后复诊，血清胰蛋白酶恢复正常，B 超或 CT 显示胰腺及周围未见异常。结论：掌握胰腺与周围脏器解剖位置关系是避免胰腺损伤的重要前提。一旦损伤胰腺，术野清晰时可在腹腔镜下进行常规外科处理，严重者需转为开腹手术，合并胰管损伤可考虑endo-GIA夹闭断裂胰腺。
목적：분석복강경수술중이선손상적원인，총결이선손상적처리방법。방법：2008년3월-2012년6월공실시복강경수술498례，이선손상20례，발생솔4.0%。결과：술후제2d후혈청이단백매평균（648±235.1）U，뇨액이단백매평균（1278±369）U，인류액이단백매평균（1368±428）U，환자생명체정평은。인류관류치（13.5±2.9）d。3개월후복진，혈청이단백매회복정상，B 초혹 CT 현시이선급주위미견이상。결론：장악이선여주위장기해부위치관계시피면이선손상적중요전제。일단손상이선，술야청석시가재복강경하진행상규외과처리，엄중자수전위개복수술，합병이관손상가고필endo-GIA협폐단렬이선。
Objective: To analyze causes of pancreas injury in laparoscopic operation and sum up solutions of pancreas injury. Methods:498 cases of laparoscopic operation were conducted from March in 2008 to June in 2012, including 20 cases of pancreas injury, and the incidence rate of pancreas injury was 4.0%. Results: 2 days after operation, the average level of trypsase in serum was(648±235.1)U, trypsase in urine was(1278±369)U, trypsase in draining liquid was(1368±428)U, and vital sign was steady. Drainage tube persisted (13.5±2.9)d, and patients had subsequent visit 3 months later, trypsase in serum was normal, type-B ultrasonic and computer tomography (CT) did not show any abnormality of pancreas and surrounding. Conclusion:It is essential to master anatomical positions of pancreas and its surrounding organs to avoid pancreas injury. Once pancreas is injured, it can be treated by surgical technique for clear field of view;laparotomy can be operated for severe cases, and endo-GIA occlusion can be applied for pancreas injury.