CAJ | 학술논문

目的：探讨胰腺外伤术后严重并发症的诊断及治疗方法。方法回顾性分析我科2009年3月—2012年12月收治的由外院转入的胰腺外伤术后严重并发症8例的临床资料。结果本组均合并胰漏、严重腹腔感染，合并腹部切口裂开4例，合并腹腔大出血3例，合并胃、十二指肠及胆总管瘘，高位小肠瘘各1例。入院后主要的治疗措施包括急诊行剖腹探查止血、胰体尾加脾切除术1例，胃造瘘加空肠营养管置入术1例，数字减影血管造影下肝左动脉加脾动脉栓塞2例，经侧腹壁小切口腹膜后脓肿清创引流术2例，腹腔双套管引流5例。本组经治疗12~79 d均获痊愈，无一例死亡，其中1例并发结肠瘘，经局部加强换药后愈合。结论针对复杂胰腺外伤术后并发症的治疗，应准确评估病情，选择合适手术干预时机，尽可能采取微创引流等方式；保持腹腔引流通畅；高度重视肠内营养，维护机体自身调节功能和免疫力；严格控制抗感染药物的应用。灵活运用上述原则是治疗成功的保证。
목적：탐토이선외상술후엄중병발증적진단급치료방법。방법회고성분석아과2009년3월—2012년12월수치적유외원전입적이선외상술후엄중병발증8례적림상자료。결과본조균합병이루、엄중복강감염，합병복부절구렬개4례，합병복강대출혈3례，합병위、십이지장급담총관루，고위소장루각1례。입원후주요적치료조시포괄급진행부복탐사지혈、이체미가비절제술1례，위조루가공장영양관치입술1례，수자감영혈관조영하간좌동맥가비동맥전새2례，경측복벽소절구복막후농종청창인류술2례，복강쌍투관인류5례。본조경치료12~79 d균획전유，무일례사망，기중1례병발결장루，경국부가강환약후유합。결론침대복잡이선외상술후병발증적치료，응준학평고병정，선택합괄수술간예시궤，진가능채취미창인류등방식；보지복강인류통창；고도중시장내영양，유호궤체자신조절공능화면역력；엄격공제항감염약물적응용。령활운용상술원칙시치료성공적보증。
Objective To summarize the clinical experiences of diagnosis and treatment of severe postoperative com-plications of traumatic pancreatitis. Methods Between March 2009 and December 2012, 8 patients with pancreatic injury undergoing operations in other hospitals were referred to our hospital because of severe complications such as severe celiac in-fection, bleeding, and pancreatic fistula, intestinal fistula, etc. The clinical data were retrospectively analyzed. Results 8 cases were complicated with pancreatic fistula and abdomen severe infection, 4 cases with abdomen wound disruption, 3 cases with peritoneal cavity hemorrhea, 1 case with gastric fistula, duodenal fistula, and common bile duct fistula, 1 case with high position-enteric fistula. The type of intervention procedures of 8 patients were as follows:1 case of laparotomy, splenectomy and resection of pancreatic body and tail, 1 case of gastrostomy and placement of jejunum nutrition tube, 2 cases of DSA guided left hepatic artery and splenic artery embolism, 2 cases of bilateral retroperitoneal abscess debridement and drainage, 5 cases of replacement of double-cannula drainage with continuous suction. All the patients were cured with no mortality. The hospital stay was 12-79 days. Colonic fistula occurred in 1 patient and healed naturally. Conclusion The key points of suc-cessful treatment include accurate assessment of the patient's condition, appropriate surgical intervention as soon and as mini-invasive as possible, emphasis on enteral nutrition and maintenance of host immunity, unobstructed intraperitoneal drainage and minimal use of anti-infection drugs.