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。
ObjectiveTo explore perioperative management model of ABO-incompatible liver transplantation. MethodsThe clinical data of ABO-incompatible caderveric liver transplantions without urgency performed in our center from July 2006 to May 2010 were analyzed retrospectively. Four patients had received an ABO-incompatible graft: AB to O in three, AB to A in one. All the cases were diagnosed as end-stage liver disese, one of them was primary hepatocellular carcinoma. ResultsFour survived to now （11 to 19 months） without severe infections and acute rejections. Two experienced coagulative disturbance and one of them had a second exploration. One developed acute renal failure and recovered with help under continuous veno-venous hemofiltration. All the cases were given 20 mg basiliximab two hours before revascularization and on day 4 after operation respectively. Splenectomy was performed in three, intravenous immunoglobulin was given in all more than seven days. Isohemagglutinin titers were basically stable and not relevant to the clinical manifestations. Antibiotic prophylaxis and immunosuppression protocol was same as the ABO compatible transplants except a 3-month-delay for steroid withdrawal. ConclusionABO-incompatible liver transplantation could be performed with appropriate perioperative management, such as basiliximab induction, splenectomy, intravenous immunoglobulin administration, and routine immunosuppression.