摘要
目的总结创伤性胰腺炎（TP）的诊治经验。方法回顾性分析2013年10月至2015年10月哈尔滨医科大学附属第一医院诊治的13例TP患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男9例，女4例；年龄28～53岁，中位年龄39岁；均有明确外伤史，主要为交通伤、挤压伤。观察患者的诊断、治疗及并发症发生情况。结果本组患者胰腺损伤以Ⅱ、Ⅲ级为主，胰头部损伤5例，胰颈、体尾部损伤8例；确诊TP时间集中在外伤后2—5d。1例患者行非手术治疗；12例行微创手术治疗，其中行经皮穿刺置管引流术治疗8例，行内镜下放置胰管支架1例，行内镜下坏死组织清除4例；8例行开腹手术治疗。12例发生并发症，腹腔或腹膜后感染9例，行微创手术治疗，其中6例合并严重多脏器损伤，行再次手术；结肠瘘5例，其中3例肠瘘与腹腔感染灶相通，行瘘口近端肠道造口、二期关闭瘘口。本组患者中位住院时间为57（17～134）d，均经治疗后痊愈出院。结论TP起病隐匿，进展迅速，早期诊断困难，应根据患者的具体情况选择个体化治疗方案。
Objective To summarize the experience of diagnosis and treatment of traumatic pancreatitis （TP）. Methods Clinical data of 13 patients with TP who were admitted to the First Affiliated Hospital of Harbin Medical University between October 2013 and October 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 9 males and 4 females, aged from 28 to 53 years old with a median age of 39 years old. All patients had a definite medical history of trauma, mainly traffic and crush injury. The diagnosis, treatment and complications of the patients were observed. Results The patients were mainly with grade ]][ and $ pancreatic damage, incluing 5 cases of pancreatic head injury and 8 of pancreatic neck, body and tail injury. Most patients were diagnosed with TP on 2-5 d after trauma. One case received non- surgical treatment. Twelve cases underwent minimally invasive surgery, including 8 cases treated with percutaneous catheter drainage, 1 with endoscopic pancreatic stent, 4 with endoscopic removal of necrotic tissue. Eight cases underwent laparotomy. Complications were observed in 12 cases. Nine cases developed abdominal or retroperitoneal infection and underwent minimally invasive surgery. Among them, 6 cases were complicated with severe multiple organ injuries and underwent re-operation. Five cases suffered colonic fistula. Among them, colonic fistula of 3 cases were interlinked with abdominal infectious focals, and they underwent fistula proximal intestinal colostomy and two-stage fistula closure. The median length of hospital stay was 57（17-134） d. All patients were recovered and discharged after treatment. Conclusions It is difficult to make an early diagnosis of TP due to the insidious onset and rapid progression. Individualized treatment should be chosen according to the specific conditions of patients.
出处
《中华肝脏外科手术学电子杂志》
CAS
2016年第6期358-362,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金(81370565
81372613
81670583)
关键词
创伤和损伤
胰腺炎
诊断
治疗学
Wounds and injuries
Pancreatitis
Diagnosis
Therapeutics
