非手術治療胰腺頸部斷裂傷 1 例并相關文獻復習_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

黃磊 , 馮新富 , 石承先 , 劉江偉 ,  黃建釗

貴州省人民醫院肝膽外科（貴陽 550002）;

Corresponding?author：

黃建釗, Email: huangjzgz@126.com

Keywords：

胰腺頸部斷裂傷; 診斷; 治療

DOI：

10.7507/1007-9424.201612001

Video：

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目的提高胰腺頸部斷裂傷治療的新認識。方法對筆者所在醫院收治的 1 例胰腺頸部斷裂傷患者的臨床資料進行分析并復習相關文獻。結果患者經過禁飲食，持續胃腸減壓，質子泵抑制劑抑制胃酸分泌，靜脈補充水、電解質，廣譜抗生素抗感染，靜脈泵入生長抑素抑制胰液分泌，行腸外營養支持，生大黃泡水后低壓灌腸，腸道功能恢復后經鼻空腸營養管行腸內營養支持，然后行經皮胰周穿刺置管引流治療，患者病情好轉趨于愈合。出院后 3 個月隨訪，腹腔引流管引流液量為 5～10 mL/d，患者可以經口進飲食，無發熱、腹痛、腹脹等臨床癥狀。結論胰腺頸部斷裂傷除了可以采用手術治療外，在患者身體狀況平穩的條件下也可以選擇非手術治療。

Citation： 黃磊, 馮新富, 石承先, 劉江偉, 黃建釗. 非手術治療胰腺頸部斷裂傷 1 例并相關文獻復習. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(8): 1008-1010. doi: 10.7507/1007-9424.201612001 Copy

1.	Khan MA, Cameron I. The management of pancreatic trauma. J R Army Med Corps, 2010, 156(4): 221-227.
2.	Lahiri R, Bhattacharya S. Pancreatic trauma. Ann R Coll Surg Engl, 2013, 95(4): 241-245.
3.	Maeda K, Ono S, Baba K, et al. Management of blunt pancreatic trauma in children. Pediatr Surg Int, 2013, 29(10): 1019-1022.
4.	Iqbal CW, St Peter SD, Tsao K, et al. Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes. J Am Coll Surg, 2014, 218(2): 157-162.
5.	Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, Ⅱ: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma, 1990, 30(11): 1427-1429.
6.	Leva E, Huscher C, Rode H, et al. Management of traumatic complete pancreatic fracture in a child: case report and review of literature. J Laparoendosc Adv Surg Tech A, 2008, 18(2): 321-323.
7.	Nadler EP, Gardner M, Schall LC, et al. Management of blunt pancreatic injury in children. J Trauma, 1999, 47(6): 1098-1103.
8.	Abbo O, Lemandat A, Reina N, et al. Conservative management of blunt pancreatic trauma in children: a single center experience. Eur J Pediatr Surg, 2013, 23(6): 470-473.
9.	田孝東, 楊尹默. 胰腺損傷診斷、分級及外科治療. 中國實用外科雜志, 2015, 35(3): 258-262.
10.	Kaman L, Behera A, Singh R, et al. Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. ANZ J Surg, 2001, 71(4): 221-225.
11.	Pugaev AV, Gordeev PS, Bagdasarov VV, et al. Conservative treatment of complete distal pancreatic fistula. Khirurgiia (Mosk), 1997, (5): 35-38.
12.	Casas M, Mora J, Fort E, et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev Esp Enferm Dig, 2007, 99(5): 264-269.
13.	Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol, 2013, 19(6): 917-922.
14.	Besselink MG, van Santvoort HC, Witteman BJ, et al. Management of severe acute pancreatitis: it's all about timing. Curr Opin Crit Care, 2007, 13(2): 200-206.
15.	劉永合. 重癥急性胰腺炎治療中早期腸內營養支持現狀及進展. 吉林醫學, 2017, 38(4): 771-773.
16.	Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study. Ann Surg, 2006, 244(6): 959-967.
17.	Mattix KD, Tataria M, Holmes J, et al. Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes. J Pediatr Surg, 2007, 42(2): 340-344.
18.	楊道貴, 孫瑞利, 徐春英. 等. 18 例小兒創傷性胰腺炎的診斷與治療. 中華創傷雜志, 1995, 11(6): 334.

1. Khan MA, Cameron I. The management of pancreatic trauma. J R Army Med Corps, 2010, 156(4): 221-227.
2. Lahiri R, Bhattacharya S. Pancreatic trauma. Ann R Coll Surg Engl, 2013, 95(4): 241-245.
3. Maeda K, Ono S, Baba K, et al. Management of blunt pancreatic trauma in children. Pediatr Surg Int, 2013, 29(10): 1019-1022.
4. Iqbal CW, St Peter SD, Tsao K, et al. Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes. J Am Coll Surg, 2014, 218(2): 157-162.
5. Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, Ⅱ: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma, 1990, 30(11): 1427-1429.
6. Leva E, Huscher C, Rode H, et al. Management of traumatic complete pancreatic fracture in a child: case report and review of literature. J Laparoendosc Adv Surg Tech A, 2008, 18(2): 321-323.
7. Nadler EP, Gardner M, Schall LC, et al. Management of blunt pancreatic injury in children. J Trauma, 1999, 47(6): 1098-1103.
8. Abbo O, Lemandat A, Reina N, et al. Conservative management of blunt pancreatic trauma in children: a single center experience. Eur J Pediatr Surg, 2013, 23(6): 470-473.
9. 田孝東, 楊尹默. 胰腺損傷診斷、分級及外科治療. 中國實用外科雜志, 2015, 35(3): 258-262.
10. Kaman L, Behera A, Singh R, et al. Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. ANZ J Surg, 2001, 71(4): 221-225.
11. Pugaev AV, Gordeev PS, Bagdasarov VV, et al. Conservative treatment of complete distal pancreatic fistula. Khirurgiia (Mosk), 1997, (5): 35-38.
12. Casas M, Mora J, Fort E, et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis. Rev Esp Enferm Dig, 2007, 99(5): 264-269.
13. Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol, 2013, 19(6): 917-922.
14. Besselink MG, van Santvoort HC, Witteman BJ, et al. Management of severe acute pancreatitis: it's all about timing. Curr Opin Crit Care, 2007, 13(2): 200-206.
15. 劉永合. 重癥急性胰腺炎治療中早期腸內營養支持現狀及進展. 吉林醫學, 2017, 38(4): 771-773.
16. Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study. Ann Surg, 2006, 244(6): 959-967.
17. Mattix KD, Tataria M, Holmes J, et al. Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes. J Pediatr Surg, 2007, 42(2): 340-344.
18. 楊道貴, 孫瑞利, 徐春英. 等. 18 例小兒創傷性胰腺炎的診斷與治療. 中華創傷雜志, 1995, 11(6): 334.

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非手術治療胰腺頸部斷裂傷 1 例并相關文獻復習

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