Diagnosis and Treatment of Pancreatic Trauma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 張升寧 , 李立 , 冉江華 , 劉靜 , 李來邦 , 高楊 , 梁宇 , 陳奕明

;

Corresponding?author：

張升寧, Email: zsn813@hoatmail.com

Keywords：

胰腺損傷; 診斷; 治療

DOI：

10.7507/1007-9424.20140022

Video：

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Abstract Full text Figures/Tables Video References Cited by

目的探討胰腺損傷的診斷和治療方法。方法回顧性分析16例胰腺損傷患者的臨床資料。結果胰腺損傷屬Ⅰ級3例，Ⅱ級5例，Ⅲ級4例，Ⅳ級3例，Ⅴ級1例；系單純胰腺損傷3例，合并其他器官損傷13例。術前確診為胰腺損傷者9例，另7例分別診斷為：脾破裂1例，肝破裂1例，開放性腹部損傷2例，空腔臟器穿孔、彌漫性腹膜炎3例。8例胰腺Ⅰ～Ⅱ級損傷者行清創、縫扎止血及胰腺周圍雙套管引流術；4例Ⅲ級損傷者行胰體尾切除+脾切除術；3例Ⅳ級損傷者，行近端胰腺斷端縫合、胰管縫扎加胰體尾空腸Roux-en-Y吻合術；對1例Ⅴ級損傷者行胰十二指腸切除術。術后發生胰瘺5例；治愈13例，死亡3例。結論早期診斷、及時手術探查以及術中選擇合理的手術方式，對降低胰腺損傷的并發癥和死亡率和改善胰腺損傷的預后均十分重要。

Citation： 張升寧, 李立, 冉江華, 劉靜, 李來邦, 高楊, 梁宇, 陳奕明. Diagnosis and Treatment of Pancreatic Trauma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(1): 98-100. doi: 10.7507/1007-9424.20140022 Copy

1.	Khan MA, Cameron I.The management of pancreatic trauma[J].J R Army Med Corps, 2010, 156(4):221-227.
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3.	Tan KK, Chan DX, Vijayan A, et al.Management of pancreatic injuries after blunt abdominal trauma.Experience at a single insti-tution[J].JOP, 2009, 10(6):657-663.
4.	Degiannis E, Glapa M, Loukogeorgakis SP, et al.Management of pancreatic trauma[J].Injury, 2008, 39(1):21-29.
5.	Thomas H, Madanur M, Bartlett A, et al.Pancreatic trauma-12-year experience from a tertiary center[J].Panereas, 2009, 38(2):113-116.
6.	Wong YC, Wang LJ, Fang JF, et al.Multidetector-row computed tomography (CT) of blunt pancreaticinjuries:can contrast-enhanced multiphasic CT detect pancreatic duct injuries?[J].J Trauma, 2008, 64(3):666-672.
7.	Linsenmaier U, Wirth S, Reiser M, et al.Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology[J].Radiographics, 2008, 28(6):1591-1602.
8.	Rekhi S, Anderson SW, Rhea JT, et al.Imaging of blunt panc-reatic trauma[J].Emerg Radiol, 2010, 17(1):13-19.
9.	Ragozzino A, Manfredi R, Scaglione M.The use of MRCP in the detection of pancreatic injuries after blunt trauma[J].Emerg Radiol, 2003, 10(1):14-18.
10.	Bhasin DK, Rana SS, Rao C, et al.Endoscopic management of pancreatic injury due to abdominal trauma[J].JOP, 2012, 13(2):187-192.
11.	Wood JH, Partrick DA, Bruny JL, et al.Operative vs nonoperative management of blunt pancreatic trauma in children[J].J Pediatr Surg, 2010, 45(2):401-406.
12.	Paul MD, Mooney DP.The management of pancreatic injuries in children:operate or observe[J].J Pediatr Surg, 2011, 46(6):1140-1143.
13.	Oláh A, Issekutz A, Haulik L, et al.Pancreatic transection from blunt abdominal trauma:early versus delayed diagnosis and surg-ical management[J].Dig Surg, 2003, 20(5):408-414.
14.	Krige JE, Thomson SR.Operative strategies in pancreatic trauma:keep it safe and simple[J].S Afr J Surg, 2011, 49(3):106-109.
15.	Rogers SJ, Cello JP, Schecter WP.Endoscopic retrograde cholangiopancreatography in patients with pancreatic trauma[J].J Trauma, 2010, 68(3):538-544.
16.	Fisher M, Brasel K.Evolving management of pancreatic injury[J].Curr Opin Crit Care, 2011, 17(6):613-617.

1. Khan MA, Cameron I.The management of pancreatic trauma[J].J R Army Med Corps, 2010, 156(4):221-227.
2. Moore EE, Cogbill TH, Malangoni MA, et al.Organ injury sca-ling, Ⅱ:pancreas, duodenum, small bowel, colon, and rectum[J].J Trauma, 1990, 30(11):1427-1429.
3. Tan KK, Chan DX, Vijayan A, et al.Management of pancreatic injuries after blunt abdominal trauma.Experience at a single insti-tution[J].JOP, 2009, 10(6):657-663.
4. Degiannis E, Glapa M, Loukogeorgakis SP, et al.Management of pancreatic trauma[J].Injury, 2008, 39(1):21-29.
5. Thomas H, Madanur M, Bartlett A, et al.Pancreatic trauma-12-year experience from a tertiary center[J].Panereas, 2009, 38(2):113-116.
6. Wong YC, Wang LJ, Fang JF, et al.Multidetector-row computed tomography (CT) of blunt pancreaticinjuries:can contrast-enhanced multiphasic CT detect pancreatic duct injuries?[J].J Trauma, 2008, 64(3):666-672.
7. Linsenmaier U, Wirth S, Reiser M, et al.Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology[J].Radiographics, 2008, 28(6):1591-1602.
8. Rekhi S, Anderson SW, Rhea JT, et al.Imaging of blunt panc-reatic trauma[J].Emerg Radiol, 2010, 17(1):13-19.
9. Ragozzino A, Manfredi R, Scaglione M.The use of MRCP in the detection of pancreatic injuries after blunt trauma[J].Emerg Radiol, 2003, 10(1):14-18.
10. Bhasin DK, Rana SS, Rao C, et al.Endoscopic management of pancreatic injury due to abdominal trauma[J].JOP, 2012, 13(2):187-192.
11. Wood JH, Partrick DA, Bruny JL, et al.Operative vs nonoperative management of blunt pancreatic trauma in children[J].J Pediatr Surg, 2010, 45(2):401-406.
12. Paul MD, Mooney DP.The management of pancreatic injuries in children:operate or observe[J].J Pediatr Surg, 2011, 46(6):1140-1143.
13. Oláh A, Issekutz A, Haulik L, et al.Pancreatic transection from blunt abdominal trauma:early versus delayed diagnosis and surg-ical management[J].Dig Surg, 2003, 20(5):408-414.
14. Krige JE, Thomson SR.Operative strategies in pancreatic trauma:keep it safe and simple[J].S Afr J Surg, 2011, 49(3):106-109.
15. Rogers SJ, Cello JP, Schecter WP.Endoscopic retrograde cholangiopancreatography in patients with pancreatic trauma[J].J Trauma, 2010, 68(3):538-544.
16. Fisher M, Brasel K.Evolving management of pancreatic injury[J].Curr Opin Crit Care, 2011, 17(6):613-617.

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