Application of Emergency Pancreaticoduodenectomy in the Treatment of Blunt Duodenal and Pancreatic Trauma
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摘要:
目的 探讨急诊胰十二指肠切除术（emergency pancreaticodenetomy，EPD）在闭合性十二指肠胰头外伤中的应用价值。 方法 回顾性分析21例闭合性十二指肠胰头外伤的病例资料，收集昆明医科大学第二附属医院自2018年1月至2020年1月治疗的21例闭合性十二指肠胰头外伤的病例资料，其中急诊行胰十二指肠切除5例为EPD组：男4例，女1例，未行急诊胰十二指肠切除术组为非EPD组，共16例：男13例，女3例，比较两组患者在平均年龄、手术时间、术中出血量、术后并发症、死亡率、住院天数等指标中的统计学差异。 结果 EPD组：平均年龄（28.60±5.18）岁，平均手术时间（270.00±47.43）min，术中出血量（450.00±165.83）mL，平均住院天数（15.00±4.85）d，术后胰瘘1例，局限性积液1例，无术后死亡病例；非EPD组：平均年龄（40.81±12.48）岁，平均手术时间（266.88±96.73）min，术中出血量（695.63±399.02）mL，平均住院天数（53.19±27.58）d，术后胰瘘11例，胆瘘5例，肠瘘6例，术后出血6例，感染12例，局限性积液9例，术后死亡3例；两组对比，EPD组患者平均年龄明显小于非EPD组（P < 0.05）且行急诊胰十二指肠手术组在平均住院日和术后感染并发症的发生上明显低于未行急诊胰十二指肠切除术组（P < 0.05）。16例患者术后门诊随访，随访时间3～24月，平均随访时间（11.64±5.57）月，EPD组5例患者术后随访无特殊，非EPD组有3例患者出院后1～5月时间因十二指肠狭窄行胃空肠吻合术后痊愈出院，有1例患者出院7月后因胆道良性狭窄内镜下塑料支架植入后好转。 结论 对于闭合性十二指肠胰头外伤的患者，在受伤不超过24 h且腹腔感染未扩散之前，急诊胰十二指肠手术是安全可行的，此种情况之下，陈氏胰肠吻合是手术成功及预后良好的重要保证。 Abstract:Objective To evaluate the value of emergency pancreaticoduodenectomy in the treatment of blunt duodenal and pancreatic head trauma. Methods Twenty one patients's clinical data who were treated in the second affiliated hospital of Kunming Medical University during January 2018 to January 2020 due to blunt duodenal and pancreatic trauma is retrospectively analyzed. Five patients underwent EPD: 4 males and 1 female; The rest of the patients without emergency pancreatoduodenectomy were non-EPD group, there are 16 cases: 13 males and 3 females. Two groups were compared in terms of average age, average operation time, average intraoperative blood loss, postoperative complications, mortality, average hospital stay and other indicators. Results In the EPD group, the average age was 28.60±5.18 years, the average operative time was 270.00±47.43 minutes, the intraoperative blood loss was 450.00±165.83 ml, the average length of hospitalization was 15.00±4.85 days, there was 1 case of postoperative pancreatic fistula, 1 case of localized effusion, and no postoperative death. In the non-EPD group: the average age was 40.81±12.48 years; the average operative time was 266.88±96.73 minutes; the intraoperative blood loss was 695.63±399.02; the average length of hospital stay was 53.19±27.58 days. There were 11 cases of postoperative pancreatic fistula, 5 cases of bile fistula, 6 cases of intestinal fistula, 12 cases of infection, 9 cases of localized effusion and 3 cases of postoperative death. The average age in the EPD group was significantly lower than in the non-EPD group（P < 0.05）. The average hospital stay and the incidence of postoperative infection complications in the emergency pancreaticoduodenal surgery group were significantly lower than in the non-EPD group（P < 0.05）. 16 patients were followed up in outpatient clinics for 3-24 months, and the average follow-up time was 11.64±5.57 months. EPD group didn't have any postoperative complications. In the non EPD group, 3 patients recovered after gastrojejunostomy due to duodenal stenosis from 1 to 5 months after discharge, and 1 patient improved after endoscopic plastic stent implantation due to benign biliary stricture 7 months after discharge. Conclusions EPD is safe and feasible for the patients with blunt duodenal and pancreatic head trauma, especially for who have been injured for less than 24 hours and whose abdominal infection has not widespread. In this case, Chen's pancreaticoduodenal anastomosis is an important guarantee for successful surgery. -
图 1 胰头离断伤行急诊胰十二指肠切除术
A：术前CT检查示胰腺横断；B：术中探查见胰腺横断面；C：手术切除标本。
Figure 1. Emergency pancreaticoduodenectomy for pancreatic head laceration
图 2 外伤十二指肠破裂坏死行急诊胰十二指肠切除术
A、B：术前CT检查示十二指肠破裂；C、D：术中探查见腹膜后巨大血肿，十二指肠降段、水平段坏死明显，但腹腔感染未扩散；E：“陈氏胰肠吻合”行胰腺断端缝合止血；F：手术标本。
Figure 2. A case of duodenal rupture and necrosis caused by trauma underwent emergency pancreaticoduodenectomy
表 1 EPD组与非EPD组一般资料比较（
$\bar x \pm s $ ）Table 1. Comparison of general information between EPD group and Non-EPD group（
$\bar x \pm s $ ）项目 EPD组急诊胰
十二指肠切除非EPD组 t/x2/z P 胃、胆道及空肠
三造瘘术单纯修补或
造瘘+引流术B超介入+内镜
胰管支架植入术n 5 8 6 2 − − 年龄（岁） 28.60 ± 5.18 40.81 ± 12.48 −3.144 0.006* 手术时间（min） 270.00 ± 47.43 266.88 ± 96.73 0.069 0.946 术中出血量（mL） 450.00 ± 165.83 695.63 ± 399.02 −1.322 0.202 术后并发症[n （%）] 胰漏 1（20.00） 5（31.25） 4（25.00） 2（12.50） − 0.119 胆瘘 0（0.00） 2（12.50） 1（6.25） 2（12.50） − 0.278 肠瘘 0（0.00） 2（12.50） 4（25.00） 0（0.00） − 0.262 术后出血 0（0.00） 3（18.75） 3（18.75） 0（0.00） − 0.262 感染 0（0.00） 5（31.25） 7（43.75） 0（0.00） − 0.006* 局限性积液 1（20.00） 4（25.00） 5（31.25） 0（0.00） − 0.311 死亡例数[n （%）] 0（0.00） 2（12.50） 1（6.25） 0（0.00） − 0.549 平均住院天数（d） 15.00（10.50，19.50） 48.00（30.00，68.25） −3.303 0.001* *P < 0.05。 
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