Sheng Xinyi,Ji Chunyi,Yuan Miaoxian,et al.Diagnosis and treatment of high-grade pancreatic trauma in children[J].Journal of Clinical Pediatric Surgery,2022,21(12):1164-1167.[doi:10.3760/cma.j.cn101785-202206061-012]
儿童高级别胰腺外伤诊治体会
- Title:
- Diagnosis and treatment of high-grade pancreatic trauma in children
- Keywords:
- Pancreatic Diseases; External injury; Pancreatectomy; Diagnosis; Therapy; Child
- 摘要:
- 目的 探讨儿童高级别胰腺外伤的治疗方法。方法 回顾性分析2018年1月至2022年1月湖南省儿童医院普外一科收治的12例Ⅲ级及以上胰腺外伤患儿临床资料,观察并总结患儿病程、临床表现、血及尿淀粉酶变化、影像学检查结果、治疗方法及预后情况。结果 12例中男7例,女5例;年龄2岁5个月至11岁7个月;于伤后5 h至15 d入院,11例血及尿淀粉酶不同程度升高,9例合并腹腔其他脏器损伤。胰腺外伤分级为Ⅲ级8例,Ⅳ级4例。8例Ⅲ级胰腺外伤中,3例行远端胰腺切除术(其中2例为保留脾脏手术,1例为远端胰腺切除加脾脏切除术);5例予保守治疗,均形成巨大假性囊肿,行穿刺加外引流术。3例Ⅲ级胰腺外伤行远端胰腺切除术患儿禁食时间及住院时间分别为(6.3±1.15)d、(15.6±6.03)d;保守治疗患儿禁食时间及住院时间分别为(30±13.2)d、(51.8±4.49)d。4例Ⅳ级胰腺外伤患儿无一例发生危及生命的严重并发症,1例行损伤控制性引流手术,3例先予保守治疗,待形成巨大胰腺假性囊肿后行内引流术;行损伤控制性引流手术患儿禁食时间及住院时间分别为43 d、56 d;保守治疗患儿禁食时间及住院时间分别为(45.3±7.1 d)、(57.3±4.4 d)。12例均痊愈出院。结论 Ⅲ级胰腺外伤行远端胰腺切除术较保守治疗能有效缩短禁食时间及住院时间,手术首选远端胰腺切除术,尽量保留脾脏。Ⅳ级胰腺外伤通常不引起危及生命的严重并发症,且引流手术较保守治疗无明显优势,建议保守治疗;若因腹腔其他脏器损伤需伤后早期手术治疗,则建议行损伤控制性引流手术。
- Abstract:
- Objective To explore the treatment of high-grade pancreatic trauma in children.Methods From January 2018 to January 2022,clinical data were retrospectively reviewed for 12 children hospitalized with grade Ⅲ or above pancreatic trauma.Course of disease,clinical manifestations,changes of blood and urine amylase,imaging studies,treatments and outcomes were recorded.Results There were 7 boys and 5 girls with an age range of (29-139) months.The course of disease ranged from 5 hours to 15 days post-injury.Elevations of blood and urine amylase were detected in 11 children.Among 9 cases complicated with abdominal organ injury,there were grade Ⅲ pancreatic injury (n=8) and grade Ⅳ pancreatic injury (n=4).Among 8 cases of grade Ⅲ pancreatic injury,three cases underwent pancreatectomy (splenic preservation,n=2;splenectomy;n=1) and giant pseudocyst was punctured with external drainage (n=5).Mean fasting time and hospital stay of grade Ⅲ children undergoing distal pancreatectomy were (6.3±1.15) and (15.6±6.03) days.The mean values of fasting time and hospital stay were (30±13.2) and (51.8±4.49) days.None of 4 cases with grade Ⅳ extrapitonal injury had life-threatening complications.One underwent injury-controlled drainage while the remainders were treated conservatively by internal drainage of giant pancreatic pseudocyst.The fasting time and hospital stay of drainage cases were 43 and 56 days.Mean fasting time and hospital stay were (45.3±7.1) and (57.3±4.4) days.All of them recovered smoothly.Conclusion Distal pancreatectomy for grade Ⅲ pancreatic trauma can effectively shorten fasting and hospital stay as compared with conservative treatment.Distal pancreatectomy is preferred for preserving spleen as much as possible.For grade Ⅳ pancreatic trauma,there is generally no serious life-threatening complication.Drainage surgery has no obvious edge over conservative treatment and conservative treatment is recommended.If other abdominal organ injuries require early post-injury surgery,injury-controlled drainage is indicated.
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备注/Memo
收稿日期:2022-6-29。
基金项目:湖南省卫健委课题(20200212)
通讯作者:尹强,Email:qiangyin@hotmail.com