吴祯乾 沈容荣 阎钧 汪昱

摘 要 胰腺损伤多继发于腹部创伤，病情重且多合并有其他器官的同时性损伤。因其缺乏特异性体征，早期诊断困难，容易发生漏诊和误诊，如果不及时处理可继发更广泛的损伤和严重并发症，病死率较高。腹部增强CT检查对诊断胰腺损伤十分重要和必要，但对胰管损伤缺乏特异性，而磁共振胰胆管造影（MRCP）或内镜逆行胰胆管造影（ERCP）对术前评估损伤分级、判断胰管损伤部位及程度更有价值。胰腺损伤的手术较为复杂，术中应注意对胰腺及十二指肠的仔细探查，以免遗漏潜在的胰腺损伤，手术方式以胰腺损伤分级为指导，根据不同的严重性采取相应的手术方式。对于存在血流动力学不稳定的重症患者应采取以挽救生命为首要目的损伤控制性手术。

关键词 胰腺损伤；胰腺损伤分级；胰管损伤；诊断；治疗

中图分类号：R576 文献标志码：A 文章编号：1006-1533（2021）18-0003-05

Clinical diagnosis and treatment of pancreatic trauma

WU Zhenqian， SHEN Rongrong， YAN Jun， WANG Yu

（Department of General Surgery， the Sixth Peoples Hospital Affiliated to Shanghai Jiao Tong University， Shanghai 200233， China）

ABSTRACT Pancreatic trauma is secondary to abdominal trauma， which is serious and always accompanied by simultaneous injury of other viscera. Due to the lack of specific signs， early diagnosis is difficult， and misdiagnosis and missed diagnosis are prone to occur. If not treated in time， more extensive injuries and severe complications can occur， and the case fatality rate is higher. Abdominal enhanced computed tomography is very important and necessary for the diagnosis of pancreatic injury， but it lacks specificity for pancreatic duct disruption， and magnetic resonance cholangiopancreatography（MRCP） or endoscopic retrograde cholangiopancreatography（ERCP） are more valuable for preoperative assessment of injury grade， location and extent of pancreatic duct disruption. The surgical treatment of pancreatic injury is complicated， during the operation， attention should be paid to careful exploration of the pancreas and duodenum to avoid missing potential pancreatic damage. The surgical method is guided by the grades of pancreatic injury， and the corresponding surgical method is adopted according to different severity. The damage control surgery should be performed to severe patients with hemodynamic instability with the primary purpose of saving life.

KEY WORDS pancreatic trauma； pancreatic injury grades； pancreatic duct injury； diagnosis； treatment

胰腺为腹膜后位器官，由于其解剖位置较深，故胰腺损伤发生率相对较低，仅占腹部创伤的3.8%，但胰腺与胃、十二指肠及肝胆系统关系密切，功能丰富，一旦损伤可带来严重的后果，其并发症发生率及病死率分别高达30%～40%和9%～34%[1-3]。胰腺损伤在西方主要见于枪伤所致的开放性胰腺损伤，而在我国则以交通事故中方向盘突然撞击上腹部所致的闭合性胰腺损伤为主。胰腺损伤往往合并有其他脏器严重损伤，且缺乏特异性体征，早期诊断困难，容易发生漏诊和误诊[4]。如果不及时处理可继发更广泛的损伤和严重并发症，甚至造成患者死亡。……