腹部创伤后急诊胰十二指肠切除手术的预后分析.docVIP

腹部创伤后急诊胰十二指肠切除手术的预后分析 任华建 王革非 顾国胜 陈军 洪之武 任建安 中国人民解放军南京总医院普通外科研究所 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的 探讨腹部创伤后急诊行胰十二指肠切除术后的预后分析。方法 回顾性分析2012年8月—2017年1月在解放军南京总医院住院治疗的17例因腹部创伤行急诊胰十二指肠切除手术患者的临床资料。其中男性15例, 女性2例;年龄1557岁, 平均37.9岁。致伤因素:道路交通伤9例, 重物砸伤或挤压6例, 刀刺伤2例, 均存在胰腺及周围脏器的损伤。分析患者术后并发症情况、平均住院时间、存活率以及病死率。比较死亡组和存活组的胰腺损伤等级、输血量和胰瘘发生率。结果 入选患者均因创伤在外院行急诊胰十二指肠切除手术, 术后因并发症转往解放军南京总医院, 经治疗11例存活, 6例死亡, 伤后平均住院时间112.6d。所有患者均存在不同程度的多发消化道瘘和腹腔感染, 其中14例消化道或腹腔出血 (82.4%) , 10例胰瘘 (58.8%) , 10例小肠瘘 (58.8%) , 9例胆瘘 (52.9%) , 8例胃肠吻合口瘘 (47.1%) , 8例结肠瘘 (47.1%) 。存活组胰腺II级损伤1例, III级损伤6例, V级损伤4例;死亡组胰腺III级损伤2例, IV级损伤1例, V级损伤3例。死亡组的胰瘘发生率83.3% (5/6) , 高于存活组的45.5% (5/11) 。存活组均有效控制出血, 平均输血量为1 873mL;死亡组最终均无法有效控制出血, 平均输血量为18 008mL。两组输血量差异有统计学意义 (P0.05) 。结论 腹部创伤后行急诊胰十二指肠切除手术的病死率和并发症发生率均明显升高, 处理过程中需积极应用损害控制外科的理念。 关键词： 腹部损伤; 十二指肠损伤; 损害控制; 急诊; 作者简介：任建安, E-mail:JiananR@ 收稿日期：2017-09-04 基金：2017年江苏省社会发展面上项目 (BE2017725) The prognostic analysis of emergency pancreaticoduodenectomy due to abdominal trauma REN Hua-jian WANG Ge-fei GU Guo-sheng CHEN Jun HONG Zhi-wu REN Jian-an Department of General Surgery, Nanjing General Hospital of PLA; Abstract： Objective To explore the prognosis of emergency pancreaticoduodenectomy (EPD) due to abdominal trauma.Methods Clinical data of seventeen patients admitted in Jinling Hospital between Aug.2012 and Jan.2017 with EPD due to abdominal trauma were retrospectively analyzed.There were 15 males and 2 females with an average age of 37.9 (15-57) years.Nine cases were injured from road traffic accidents, 6 were from heavy objects or crush, and 2 were from knife stab.All patiens had injuries of pancreas and surrounding organs.Complications, hospital stay, survival rate and death rate were analyzed.Degree of pancreatic injury, blood transfusion volume and incidence of pancreatic fistula were compared.Results All the cases admitted were preformed EPD in other hospitals due to trauma, then transferred to our institute for postoperative