闭合性胰腺损伤的临床诊断和手术.pdfVIP

实用医学进修杂志 2007年第35卷第4期 JOURNALOF PRACTICALTRAININGOFMEDICINE Vo1．35 N 4 Dee．20O7 · 232· 闭合性胰腺损伤的临床诊断和手术 王 钧 郑九星 徐晓萍 王丰铃 张光辉 陈孝平 1 三峡大学校医院(宜昌443o02) 2 三峡大学第三临床医学院 3 华中科技大学同济医学院附属同济医院肝胆中心 摘 要 目的：提高闭合性胰腺损伤的早期诊断水平，掌握好探查指征，合理选择手 术方式。方法：回顾性分析18年来3O例闭合性胰腺损伤的诊治过程。结果：闭合性胰 腺损伤临床上均有不同程度的上腹疼痛、呕吐、腹膜刺激征，其中休克4例，早期血淀粉 酶检查24例，20例阳性；尿淀粉酶16例，8例阳性，腹水淀粉酶8例，均为阳性，腹穿16 例均为阳性。B超检查24例，确诊12例，CT检查13例，确诊ll例，病发症发生率50％ (15／30)死亡3例。结论：早期诊断闭合性胰腺损伤主要依靠临床表现、诊断性腹腔穿 刺、淀粉酶检查和B超及CT检查、各种辅助检查有一定的局限性，术前提高对胰腺损伤 程度的认识，掌握好探查指征，合理选择手术方式，可以进一步降低并发症及死亡率。 关键词 外科手术；胰腺疾病；创伤 The Diagnosis and Surgerg of Closed Pancreatic Trauma Wang Jun Zheng Jiuxin Xu Xiaoping，et a1． China Three Gorges University，Yichang 443002，China Abstract 0bjeetive：To improve early diagnosis of blunt pancreatic trau— ma，mastering operative indication and selecting operative piogram correctly． Methods： Retrospective review the diagnosis and treatment of 30patients with blunt pancreatic trauma in our hospital in the 1 8 years．Results：The upper ab— dominal pain was complained in all cases were accompanied by shock．24 of 20 cases had high level of serum amylase．8 of 1 6 cases had high level of urinary amylase．Peritoneal puncture was present in 1 5 patients．30 cases had complica— tions and 3 died．Conelusions：Early identification of blunt pancreatic trauma re— lies on clinid symptoms，signs diagnostic peritoneal puncture，pancreatic amylase， B—US and CT．The result showed that limitations，improving preoperative acces— sory examimation，mastering operative indication and selecting operative program correctly would reduce the comp；ication and mortality． Key words surgical；pancreas disease；hurt 作者简介：王 钧(1960一)，男，副主任医师。 实用医学进修杂志 2007年第35卷第4期 JOURNAL OF PRACrICAL删 MNG 0F M聊 (=INE V0L 35№ 4 Dee． ∞