胰腺外伤40例的个体化诊治.pdfVIP

中华普通外科学文献 (电子版)2011年6月第5卷第3期ChinArchGenSurg (ElectronicEdition)，June2011，Vol5，No-3 · 论 著 · 胰腺外伤4O例的个体化诊治 李清汉 甄作均 陈焕伟 摘【要】 目的 探讨胰腺外伤的个体化处理措施。方法 回顾性分析我院近 10年来收治的40例 胰腺外伤患者的资料。结果 40例患者中12例行保守治疗 ，28例行手术治疗。其中行单纯手术引流6 例，清创修补引流术 11例，B超引导经皮穿刺置管引流3例，行胰尾或胰体尾切除术4例 ，右半肝+远 端胰腺 +脾切除 1例，远端胰腺 胃吻合 +空肠造瘘 1例 ，胰十二指肠切除 1例 ，肝、胆总管、十二指肠、 胰修补+胃及空肠造瘘 1例。治愈38例，死亡2例，发生胰瘘4例，十二指肠漏 1例。结论 根据胰腺 外伤的位置和程度 ，选择个体化的治疗方法是提高胰腺外伤治愈率的关键。B超引导下穿刺置管引流 及胰胃吻合等方法提供了一种新的治疗思路。 【关键词】腹部损伤；胰腺；治疗；胰腺瘘 Individualmanagementforpancreasinjuriesof40cases LIQing-han，ZHENZuo-jun，CHENHuan- wei．DepartmentofHepaticSurgeryandPancreaticSurgery,theFirstPeople’HospitalofFoshan，Foshan 528000,China Correspondingauthor：ZHENZuo-jun,Email：zzjun@fsyyy．com A【bstrac】 Objective Todiscusstheindividualmanagementfortheinjuriesofpancreas．Method Fortypatientswith injuriesofpancreastreatedduringthelast10yearsinourhospital，wereanalyzed retrospectivelyofrthesurgicaltreatmentand theirclinicalresults．Results Twelvecasesweretreated by conservativetreatment，and 28 caseswere treated by operation．Simpleclosed suction drainageRealthe pancreaticbedwasperformedin6patients．Debridement，sutureandclosedsuctiondrainagewereperformedin ll patients．Ultrasound guided percutaneous catheter drainage was perfomr ed in 3 patients．Distal pancreatectomywasperfomr edin4patients．Resectionof therightsideoftheliver，thedistalpancreasandthe spleenwasperfomredin1patient．Pancreaticogastrostomyandjejnnum stomawereperformedin1patient． Pancreatoduodenectomywasperfomr edin 1patient．Repairoftheliver，thecommonbileduct，theduodenum， andhtepancreas，combinedwithjejunum stomaandgastrosotmywereperfomredin1patient．Thirty—eight patientswerecured，nad2patientsdied．Pancreaticfistulaoccurredin4cases．Conclusions Th eprincipleof individualization ishte key to improvethe effectoftreatmentaccordingtothe characteristics oftrauma． Ultrasound guided percutaneouscatheter