闭合性胰腺损伤16例诊治的的体会.docVIP

闭合性胰腺损伤16例诊治的的体会 　　【中图分类号】 R576 【文献标识码】B【文章编号】1672－3783(2011)04－0217－01 　　 　　【摘要】目的 探讨闭合性胰腺损伤的诊断与治疗方法。方法 回顾分析16例闭合性胰腺损伤的临床资料，对其诊断与治疗方法进行探讨。结果 本组16例均行手术治疗，治愈15例，死亡1例。术前诊断胰腺损伤8例，其余均在术中探查明确。本组10例作胰腺CT疑似胰腺损伤7例；12例作B超检查提示有胰周积液3例；12例腹穿抽出血性腹液，腹液淀粉酶升高8例；血淀粉酶高4例；尿粉酶升高3例。结论 胰腺损伤的诊断须综合病史、临床表现、辅助检查全面考虑，手术须据不同损伤择不同术式。重度胰腺损伤重视充分引流、空肠造瘘和损伤控制性手术也许更有利于抢救生命和术后康复。 　　【关键词】 胰腺损伤；诊断；治疗；空肠造瘘；损伤控制 　　 　　Experience of 16 cases of blunt pancreatic injury diagnosis and treatment 　　ZHANG Liang-qing，GAO Hai-hong， WU Hao-yuan，HUANG Min-biao 　　 　　【Abstract】 Objective To investigate the diagnosis of blunt pancreatic injury and treatment. Methods Retrospective analysis of 16 cases of blunt pancreatic injury in clinical data, its diagnosis and treatment are discussed. Results 16 patients underwent surgical treatment, 15 patients were cured and 1 died. Preoperative diagnosis of pancreatic injury in 8 cases, the rest were clear in the intraoperative exploration. The group of 10 patients with pancreatic CT for suspected pancreatic injury in 7 cases; 12 cases of B-ultrasound for peripancreatic effusion suggestive of 3 cases; 12 cases out of bloody abdominal paracentesis fluid, abdominal fluid amylase 8; high serum amylase 4; 3 cases of increased urinary enzyme powder. Conclusion The diagnosis of pancreatic injury to be comprehensive history, clinical manifestations, laboratory examinations take full account of the surgery to be selected according to various different surgical injury. Heavy emphasis on adequate drainage of pancreatic injury, jejunum fistula and damage control may be more conducive to life-saving surgery and postoperative rehabilitation. 　　【Key words】 Pancreatic injury;Diagnosis; Treatment;Jejunum ostomy; Damage control 　　胰腺损伤约占腹部外伤的1%-3%，常合并多脏器损伤，伤情复杂，严重并发症多，诊治困难，死亡率高。我院于1999年5月至2010年6月共收治闭合性胰腺损伤16例，现将诊治情况报告如下：? 　　1 临床资料 　　1.1 一般资料 本组共16例，其中男11例，女5例，年龄9-50岁，平均30岁。单纯胰腺损伤2例，合并其它脏器损伤14例。车祸伤11例，重物压伤1例，高处坠落伤3例，顿物撞击伤1例。合并肝损伤2例、十二指肠破裂伤4例、脾损伤2例、横结肠损伤1例、胃损伤5例、大网膜损伤8例、血胸1例、四肢损伤5例。合并休克