摘要
背景与目的:胰腺创伤是多种因素引起胰腺解剖结构或功能破坏,通常分为闭合性和开放性,但是胰腺创伤并不常见,一旦发生,通常合并多器官的损伤,而且胰腺特殊的解剖位置给诊断和治疗带来难度,所以胰腺创伤的高病死率与诊断和治疗的延误有关。近年来,随着我国工业化的进步,胰腺创伤的发病有升高的趋势,致伤因素与地域也有关系。因此,本研究总结单中心15年胰腺创伤的致病因素、创伤分级和治疗方式,以期获取经验指导临床实践。方法:回顾性分析2008年1月—2022年12月中国人民解放军空军军医大学第一附属医院收治的147例胰腺创伤患者的临床资料,根据美国创伤外科协会(AAST)标准进行胰腺创伤分级,归纳分析致病原因、创伤分级以及相对应的治疗方式和转归。结果:开放伤15例,闭合伤132例。最多的致病因素为车祸伤65例(44.22%),剩余依次为打架斗殴伤(钝器或锐器)28例(19.05%),高坠伤为18例(12.24%),外伤为10例(6.80%),摔伤、碰撞伤(非车祸伤)8例(5.44%),挤压伤4例(2.72%),炸伤1例(0.68%),不明原因伤13例(8.84%)。根据AAST标准分级,Ⅰ级58例(39.46%),Ⅱ级15例(10.21%),Ⅲ级54例(36.73%),Ⅳ级9例(6.12%),Ⅴ级11例(7.48%)。80例(54.42%)行外科治疗,高级别损伤(Ⅲ~Ⅴ级)的手术率达95.95%,涉及的手术方式有胰体尾切除术44例,胰十二指肠切除术11例,胰肠吻合术5例,胰腺清创、修补、引流术19例,胰头胰管修补术联合胰体尾切除术1例;62例(42.18%)行保守治疗;5例(3.40%)行内镜治疗。62例保守治疗治愈24例(38.71%),好转37例,死亡1例;80例外科干预治疗治愈66例(82.50%),好转9例,恶化3例,死亡2例;5例内镜治疗均好转。结论:胰腺创伤致病因素多见于车祸、打架斗殴、高坠伤等,治疗方式中Ⅰ~Ⅱ级胰腺创伤大部分可行保守治疗,Ⅲ~Ⅴ级主要以外科治疗为主,主要行胰体尾切除或胰十二指肠切除术,对于严重的高级别胰腺创伤急行外科干预是必要选择,即使是低级别创伤也应根据实际选择相对应积极的干预方式。胰腺创伤需要根据致病因素、创伤程度、患者全身情况以及单位医疗水平制定个体化治疗方案。
Background and Aims:Pancreatic trauma,resulting from various factors leading to structural or functional damage to the pancreas,is typically categorized into closed and open injuries.However,pancreatic trauma is not common,and when it occurs,it often accompanies injuries to multiple organs.The unique anatomical location of the pancreas poses challenges in diagnosis and treatment,contributing to the high mortality rate associated with pancreatic trauma,which is often related to delays in diagnosis and treatment.In recent years,with the advancement of industrialization in China,there has been an increasing trend in the incidence of pancreatic trauma,which is also influenced by geographical factors.Therefore,this study was performed to summarize the causes,injury grading,and treatment modalities of pancreatic trauma over a 15-year period at a single center,with the intention of gaining experiential guidance for clinical practice.Methods:The clinical data of 147 patients with pancreatic trauma admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2008 to December 2022 were retrospectively analyzed.Pancreatic trauma was graded according to the criteria of the American Association for the Surgery of Trauma(AAST),and the causes,injury grading,corresponding treatment modalities,as well as outcomes were analyzed and summarized.Results:There were 15 cases of open injury and 132 cases of closed injury.The most common etiological factor was motor vehicle accidents,accounting for 65 cases(44.22%),followed by physical altercations(blunt or sharp) in 28 cases(19.05%),falls from height in 18 cases(12.24%),other traumas in 10 cases(6.80%),non-traffic-related falls or collisions in 8 cases(5.44%),compression injuries in 4 cases(2.72%),blast injuries in 1 case(0.68%),and 13 cases(8.84%) of injuries with unknown causes.According to the AAST criteria,there were 58 cases of grade I(39.46%),15 cases of grade Ⅱ(10.21%),54 cases of grade Ⅲ(36.73%),9 cases of grade Ⅳ(6.12%),and 11 cases of grade Ⅴ(7.48%).Surgical intervention was performed in 80 cases(54.42%),with a surgery rate of 95.95% for high-grade injuries(grade Ⅲ-Ⅴ).Surgical procedures included distal pancreatectomy in 44 cases,pancreaticoduodenectomy in 11 cases,pancreaticojejunostomy in 5 cases,pancreatic debridement,repair,and drainage in 19 cases,and combined pancreatic head and pancreatic duct repair with distal pancreatectomy in 1 case.ConservatⅣe treatment was performed in 62 cases(42.18%),and endoscopic treatment in 5 cases(3.40%).Among the conservatⅣely treated patients,24 cases(38.71%) were cured,37 cases improved,and 1 case died.Among the surgically treated patients,66 cases(82.50%) were cured,9 cases improved,3 cases deteriorated,and 2 cases died.All 5 patients undergoing endoscopic treatment showed improvement.Conclusion:The causative factors of pancreatic trauma are commonly associated with traffic collisions,physical altercations,and falls from height.For grade Ⅰ-Ⅱ pancreatic trauma,conservative treatment is mostly feasible,while grade Ⅲ-Ⅴ primarily require surgical intervention,especially distal pancreatectomy or pancreaticoduodenectomy.Prompt surgical intervention is necessary for severe high-grade pancreatic trauma,and even for low-grade injuries,appropriate proactive intervention should be selected based on actual conditions.Pancreatic trauma requires individualized treatment plans based on the pathogenic factors,injury severity,the patient's overall condition,and the medical capabilities of the institution.
作者
拜云虎
南博
张宁
邓世洲
王振华
陈系羽
郑倩雯
孙毓泽
王亚云
杨雁灵
BAI Yunhu;NAN Bo;ZHANG Ning;DENG Shizhou;WANG Zhenhua;CHEN Xiyu;ZHENG Qianwen;SUN Yuze;WANG Yayun;YANG Yanling(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China;National Demonstration Center for Experimental Preclinical Medicine Education,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China;Department of General Surgery,988 Hospital of Joint Logistic Support Force,Zhengzhou 450000,China;Department of General Surgery,967 Hospital of Joint Logistic Support Force,Dalian 116000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2024年第3期386-392,共7页
China Journal of General Surgery
基金
国家自然科学基金资助项目(81870415,82000551)。
作者简介
拜云虎,中国人民解放军空军军医大学第一附属医院博士研究生/中国人民解放军联勤保障部队第九八八医院主治医师,主要从事肝胆脾外科临床及基础方面的研究;通信作者:杨雁灵,Email:yangyanl@fmmu.edu.cn。
