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丁威威 三甲
丁威威 副主任医师
南京大学医学院附属金陵医院 普通外科

我们是怎么治疗胰腺外伤的(已被权威杂志收录)

胰腺外伤单中心136例诊治报告

丁威威,王凯,刘宝晨,习丰产,汪志明,李维勤,黎介寿南京大学医学院附属金陵医院普通外科丁威威

中国人民解放军南京总医院普通外科,江苏南京210002

摘要

目的:总结单中心10年胰腺外伤治疗经验。方法:回顾性分析2008年1月至2017年12月中国人民解放军南京总医院普通外科收治的136例胰腺外伤病人的临床资料,根据美国创伤外科协会(AAST)标准进行胰腺外伤分级,随访观察并发症发生情况及预后。结果:闭合伤131例,开放伤5例。腹部CT检查(64.0%)是胰腺外伤最主要的诊断方式。37例(27.2%)非手术治疗中,13例Ⅲ级或Ⅳ级胰腺外伤病人经保守治疗获得成功;99例(72.8%)病人行手术治疗。整体并发症发生率为49.3%,主要并发症包括腹腔内并发症[腹腔脓肿(27.9%)、胰瘘(25.0%)、肠瘘(14.7%)、腹腔出血(12.5%)、胰腺假性囊肿(5.9%)、创伤性胰腺炎(5.88%)]和全身并发症[肺部感染(11.8%)、休克(7.4%)、急性呼吸窘迫综合征(5.9%)、肾功能不全(5.2%)、多器官功能障碍综合征(6.6%)]。病死率为8.1%(11/136),胰腺坏死、胰瘘及感染所致的多器官功能衰竭是最主要的死亡原因。结论:大部分轻度胰腺外伤可行保守治疗,内镜下主胰管支架植入可应用于血流动力学稳定的Ⅲ、Ⅳ级胰腺外伤病人,手术引流适用于合并腹部其他器官损伤的低级别胰腺外伤。高级别胰腺外伤应遵循损伤控制外科理念,选择合理的手术方式。根据胰腺外伤的严重程度和全身情况,个体化选择治疗方案,加入多学科综合治疗协作组模式有助于降低病死率。

关键词:胰腺外伤,非手术治疗,胰腺切除,外科引流,损伤控制

Abstract:

Management of pancreatic trauma:A report of 136 cases DING Wei-wei,WANG Kai,LIU Bao-chen,et al.Research Institute of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,ChinaCorresponding author:LI Jie-shou,E-mail:lijieshounj@163.comAbstract Objective To summarize experience of management of pancreatic trauma.Methods A retrospective review was performed of all patients with pancreatic injury admitted to Nanjing General Hospital over a 10-year period between January 2008 and December 2017.Traumatic injuries of the pancreas were graded according to the American Association for the Surgery of Trauma(AAST)score.Complications and outcomes were also collected.Results A total of 136 patients diagnosed with pancreatic trauma were included.Mechanism of injury included 131 of blunt trauma and 5 of penetrating trauma.Initial diagnosis was made by computed tomography in 87 patients(64.0%),and CT scan was proposed as the first-line diagnosis method.Thirty-seven patients(27.2%)were managed non-operatively while 99 patients(72.8%)received surgical intervention.Overall complication rate was 49.3%.The most common intra-abdominal complication was intra-abdominal abscess(27.9%),and pulmonary infection was considered as the most common systemic complication.In-hospital mortality was 8.1%(11/136),of which MODS caused by pancreatic necrosis,pancreatic fistula and abdominal sepsis were the main cause of death.Conclusion Low-grade pancreatic injuries could be managed with NOM(non-operative management)successfully.Pancreatic duct stent placement procedure could be applied to those patients with hemodynamically stable.Surgical drainage was suitable for low-grade pancreatic injury patients with associated intra-abdomen injury.Damage control surgery was recommended for high grade pancreatic injuries.Individualized treatment options for pancreatic trauma according to AAST grade and location of injury were recommended.An individual-centered,multidisciplinary approach was recommended in the management of pancreatic trauma,which significantly reduces mortality.

Key words:pancreatic trauma non-operative management pancreatectomy surgical drainage damage control surgery

丁威威,王凯,刘宝晨等.胰腺外伤单中心136例诊治报告[J].中国实用外科杂志,2018,38(07):782-785.

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丁威威
丁威威 副主任医师
南京大学医学院附属金陵医院 普通外科
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