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yxfbbiedtj · Wysłany: Śro 16:14, 09 Mar 2011

Diagnosis of pancreatic injury and surgical treatment (report of 39 cases)

Injury, early surgical exploration is the most simple and reliable early detection methods, should also be clear whether the main pancreatic duct injury, can be diluted 4 times into the blue ends of the normal pancreatic tissue damage was observed in the wound with or without overflow. If there is duodenal contusion, but also through the gap-line dilution of the nipple tube low-pressure injection of methylene blue to observe the blue spill site, a higher accuracy of the Act. Principle is debridement surgery to stop bleeding,[link widoczny dla zalogowanych], preservation of pancreatic function, adequate drainage and appropriate handling associated injury. For I, Ⅱ grade injury, can be simple external drainage after debridement. The general line of pancreatic injury grade Ⅲ distal splenectomy, for young patients, under the premise of ensuring effective treatment, as spleen-preserving surgery line:, 3 patients in this group were cured. Ⅳ grade of injury should strive for simple operation, such as the site of injury to the right of the superior mesenteric vessels, the distal pancreas line Roux-en-Y jejunal anastomosis to retain the internal and external secretory function of the pancreas, the group of 6 patients, 2 patients pancreatic fistula cured by drainage; such as damage to the left, then the removal of the remote at the same time as the Ministry of damage ampulla 567 * Additional duodenum (modified) diverticulum of the surgery. Of duodenal injury and is often accompanied by other severe associated injuries of the V-level damage, should first IX; L, two distal pancreatic surgery to Roux-en-Y jejunal anastomosis,[link widoczny dla zalogowanych], additional duodenal diverticulum of the more improved rational, fully preserved internal and external secretory function of the pancreas, but also closer to the physiological state of the gastrointestinal tract. 7 patients in this group, only 2 patients died of postoperative MODS. Emergency line of mortality of pancreaticoduodenectomy as high as 35:, only as a last resort. 3. The laparoscopic drainage: Hata et al: Report of a case of rupture of small pancreatic duct and drainage of laparoscopic repair achieved good results. We selected 8 patients with suspected pancreatic injury, but mild abdominal signs, hemodynamic stability in patients with blunt abdominal trauma by laparoscopic surgery. Surgery in 5 cases diagnosed as I, Ⅱ grade of pancreatic injury, debridement, bleeding, place of multiple double pipe, postoperative continuous irrigation, drainage and low-pressure cured; another 3 cases of intra-abdominal surgery in a small amount of net absorption bloody fluid, see a saponification omental patch,[link widoczny dla zalogowanych], pancreatic tail with splenic rupture, conversion to open splenectomy line tail of the pancreas,[link widoczny dla zalogowanych], were cured. Our preliminary view is, as long as properly selected patients, laparoscopic exploration, both to confirm the diagnosis, but also on the I, Ⅱ grade injury patients really effective drainage,[link widoczny dla zalogowanych], and even some Ⅲ, Ⅳ grade injured patients distal pancreatectomy surgery, this method can reduce surgical trauma, and promote the patient's recovery.