Objective: To summarize the experience of treatment for blunt pancreatic trauma. Methods: The clinical data of 52 patients with blunt pancreatic trauma admitted to the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2018 were analyzed retrospectively.There were 40 male and 12 female patients, aging from 12 to 112 years with a median age of 35.5 years.According to the organ injury scale by American Association for the Surgery of Trauma(AAST) for pancreatic injury severity, 15 cases were in grade Ⅰ(28.8%), 20 cases were in grade Ⅱ(38.5%), 10 cases were in grade Ⅲ(19.2%),5 cases were in grade Ⅳ(9.6%) and 2 cases were in grade Ⅴ(3.8%). Isolated blunt pancreatic trauma occurred in 11(21.2%) patients including 5 cases of grade Ⅰ,5 cases of grade Ⅱ and 1 case of grade Ⅲ, and associated injuries existed in 41 patients(78.8%). Results: Among 52 patients, 36 patients(69.2%) were transferred from other hospitals and 16(30.8%) patients were admitted through the emergency department. Finally, 49 patients(94.2%) were cured and 3 patients (5.8%) died.For the 15 cases of grade Ⅰ,9 patients were managed non-operatively, 5 cases underwent peritoneal lavage and drainage after surgery for the other injured abdominal organs, and 1 patient received percutaneous catheter drainage(PCD) with non-operative treatment. For the 20 cases of grade Ⅱ,4 cases only received non-operative treatment and 2 cases also received PCD. Besides, 2 cases underwent debridement and drainage for peripancreatic necrotic tissue and external drainage for pancreatic pseudocyst retrospectively after about 25 days of getting injured. As for patients who received exploratory laparotomy, 5 patients underwent suture repair associated with external drainage, and 7 patients were managed only with external drainage. For the 10 cases of grade Ⅲ,6 patients were cured through distal pancreatectomy and splenectomy with external drainage, while 2 patients underwent endoscopic retrograde cholangiopancreatography and ductal stenting, and the other 2 patients just received debridement and drainage for peripancreatic necrotic tissue.For the 5 cases of grade Ⅳ,2 patients underwent jejunostomy and abdominal cavity drainage, 1 patient had a pancreaticoduodenectomy with drainage,1 patient received suture repair of the pancreas and pancreaticojejunostomy, and 1 patient was managed with suture repair of the head of pancreas and external drainage.For the 2 patients of grade Ⅴ,1 patient received exploratory laparotomy and gauze compression packing hemostasis, and the other patient underwent pancreaticoduodenal repair, gastrointestinal anastomosis, duodenal exclusion surgery and external drainage. Conclusion: According to the AAST classifications, associated injuries, physiological status and intraoperative situation, it could be better to make a comprehensive judgment, achieve early diagnosis and take appropriate individualized treatment strategy, and to improve the overall therapeutic effect for blunt pancreatic trauma.
目的： 探讨闭合性胰腺损伤的治疗经验。 方法： 回顾性收集2013年1月至2018年6月哈尔滨医科大学附属第一医院胰胆外科诊治的52例闭合性胰腺损伤患者的临床资料。男性40例，女性12例，年龄12~112岁，中位年龄为35.5岁。根据美国创伤外科学会（AAST）胰腺损伤分级：Ⅰ级15例（28.8%），Ⅱ级20例（38.5%），Ⅲ级10例（19.2%），Ⅳ级5例（9.6%），Ⅴ级2例（3.8%）。孤立性闭合性胰腺损伤11例（21.2%）（Ⅰ级5例、Ⅱ级5例、Ⅲ级1例），存在合并伤41例（78.8%）。 结果： 52例患者中，外院转诊36例（69.2%），急诊入院16例（30.8%）。其中49例（94.2%）获得治愈，3例（5.8%）死亡。Ⅰ级胰腺损伤的15例患者中，9例经非手术治疗治愈，5例因合并其他腹腔器官损伤行确切手术治疗后冲洗腹腔并放置外引流管，1例通过非手术治疗联合经皮穿刺置管引流术（PCD）治愈。Ⅱ级胰腺损伤的20例患者中，4例经单纯非手术治疗，2例联合PCD治愈，2例因受伤约25 d后分别行胰腺坏死组织清除引流和胰腺假性囊肿外引流，5例行胰腺缝合修补联合外引流术，7例仅行外引流术。Ⅲ级胰腺损伤的10例患者中，6例行胰体尾脾切除术联合外引流术，2例行经内镜逆行性胰胆管造影下的胰管支架置入，2例仅行胰腺周围坏死组织清除联合外引流术。Ⅳ级胰腺损伤的5例患者中，2例行腹腔引流术联合空肠营养造口，1例行胰十二指肠切除联合腹腔引流术，1例胰腺修补、胰腺空肠吻合，1例行胰头修补联合外引流术。Ⅴ级胰腺损伤的2例患者中，1例行剖腹探查、纱布填塞止血，1例行胰头十二指肠修补、胃肠吻合、十二指肠旷置联合腹腔外引流。 结论： 根据AAST分级、合并伤情况、生理状态及术中情况综合判断，应对闭合性胰腺损伤患者早期诊断并选择个体化治疗策略，以提高整体救治效果。.
Keywords: Abdominal cavity drainage; Abdominal injuries; Blunt pancreatic trauma; Damage control surgery; Surgical procedures, operative.