胰腺外伤的救治.DOCVIP

临床医学论文-胰腺外伤的救治 【摘要】? 总结胰腺外伤的处理经验。方法 对我院1996年1月～2007年12月经治的42例胰腺外伤的临床资料，包括损伤程度、手术方式、疗效及术后并发症进行回顾性分析。结果 Ⅰ、Ⅱ级18例，Ⅲ级10例，Ⅳ级9例，V级5例。行单纯缝合引流18例，行远端胰腺切除、近端缝合结扎10例，其中保脾2例，行近端缝合结扎、远端与空肠吻合6例，近端与空肠吻合、远端切除4例，胰十二指肠切除3例，暂缝扎断端、二期手术1例。痊愈38例，死亡4例，其中死于胰瘘2例，合并颅脑外伤1例，肠瘘、多器官功能衰竭1例。结论 根据术中具体情况决定手术方式，充分引流、预防术后并发症是治疗胰腺外伤关键。 【关键词】? 胰腺外伤 外科手术 治疗 ???? Treatment on pancreas trauma (report of 42 cases) ??? ［Abstract］? Objective? To investigate the treatment of pancreatic trauma.Methods? Clinical data of 42 patients with pancreatic trauma treated from 1996 to 2007 was retrospectively analyzed，including degree of injury，operative management，and? complication.Results? There were 18 cases of pancreatic trauma in grade 1 and 2，10 in grade 3，9 in grade 4，5 in grade 5.18 patients underwent simple drainage of pancreatic effusion.10 patients were subjected to distal partial resection of pancreas and proximate pancreas suture ligature; two of them were spleen reservation.6 patients underwent anastomosis of distal pancreatic duct and jejunal mucosa and proximate pancreas suture ligature.4 patients suffered from distal pancreatectomy and anastomosis of proximate pancreatic duct and jejunal mucosa.3 patients were subjected to pancreaticoduodenectomy.Suture pancreatic incision for the second operation in one patient.There were 38 patients cured on postoperation，and 4 died，of all，2 died from pancreatic fistula，1 combined with brain injury，1 intestinal fistula and MODS.Conclusion? The choice of surgical procedure of pancreatic trauma should be made on the basis of the location，type and severity of the pancreatic trauma，so as to decrease the morbidity and mortality and to improve the outcome of the pancreatic trauma. ??? ［Key words］? pancreatic trauma；surgery；treatment ??? 随着交通事故日益增多，胰腺外伤较早诊断较困难，且病情危重治疗棘手，并发症多，病死率较高。1996年8月～2007年12月笔者共诊治胰腺外伤42例，现将救治体会报告如下。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 本组42例，男32例，女10例，年龄16～52岁，其中开放性损伤6例（刀刺伤），闭合性操作36? 例（车祸32例，钝器伤4例）。损伤体尾部17例，颈部11例，头部6例，其中合并十二指肠损伤4例，尾部合并结肠损伤2例，合并脾破裂3例，合并肝损伤5例。 ???