儿童外伤性胰腺炎13 例报告
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段栩飞, Email: alendxf6@hotmail.com

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Traumatic pancreatitis in children: a report of 13 cases
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    目的:探讨儿童外伤性胰腺炎的临床特点及诊治方法。 方法:回顾性分析2003年1月—2011年12月收治的13例外伤性胰腺炎患儿的临床资料。 结果:13例患儿中,男8例,女5例;年龄5~12(7.22±3.54)岁。病因包括腹部钝挫伤7例,车祸伤4例,坠落伤2例,均为腹部闭合性损伤。9例胰腺I级损伤(2例合并肝挫伤)和3例II级损伤均采用抗感染、禁食、胃肠减压、全静脉营养,抑酶等保守治疗,其中4例出院1~2个月后并发胰腺假性囊肿,1例经对症治疗自行吸收,3例行囊肿空肠Roux-en-Y吻合术(其中1例腹腔镜下探查拟镜下吻合未成功中转开腹);1例胰腺III级损伤(合并脾挫伤)行腹腔镜下腹腔引流术,术后1个月并发胰腺假性囊肿,行腹腔镜探查,囊肿空肠Roux-en-Y吻合术。所有患儿均治愈。 结论:儿童外伤性胰腺炎应根据胰腺损伤程度不同采取不同治疗方法。腹腔镜下腹腔引流术是治疗儿童III级外伤性胰腺炎的有效方法之一,但与腹腔镜下胰腺假性囊肿空肠吻合术一样仍需要进一步探索与总结。

    Abstract:

    bjective: To investigate the clinical features, diagnosis and treatment of traumatic pancreatitis in children. Methods: The clinical data of 13 children with traumatic pancreatitis admitted from January 2003 to December 2011 were retrospectively analyzed. Results: The 13 patients, 8 boys and 5 girls, were aged 5–12 (7.22±3.54) years. The traumatic causes were due in 7 cases to abdominal contusion, in 4 cases to traffic-related accidents and in 2 cases to falls, and all of them were blunt abdominal injuries. Nine cases with class I pancreatic injury (2 cases with concomitant liver contusion), and 3 cases with class II pancreatic injury received conservative management such as intravenous antibiotics, fasting, gastrointestinal decompression, total parenteral nutrition, and pancreatic enzyme inhibition, and 4 of them developed a pancreatic pseudocyst at 1 month to 2 months after discharge, of whom the lesion spontaneously resolved in 1 case after symptomatic treatment, and 3 cases were treated by internal drainage by means of a Roux-Y cysto-jejunostomy (in one case laparoscopic anastomosis could not be done after endoscopic exploration, and was converted to open surgery). One case with class III pancreatic injury (accompanied with splenic contusion) underwent laparoscopic abdominal drainage, but developed a pancreatic pseudocyst 1 month later, and then underwent endoscopic exploration and Roux-Y cysto-jejunostomy. Eventually, all the patients were completely cured. Conclusion: The selection of treatment of traumatic pancreatitis in children should be based on the degree of pancreatic injury. Laparoscopic abdominal drainage is one of the effective methods for traumatic pancreatitis in children with class III injury, however, as well as laparoscopic Roux-Y cysto-jejunostomy, it requires further exploration and consideration.

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朱真闯|段栩飞|卞红强|杨俊|郑凯|梁翀|闫学强.儿童外伤性胰腺炎13 例报告[J].中国普通外科杂志,2013,22(3):340-343.
DOI:10.7659/j. issn.1005-6947.2013.03.017

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  • 收稿日期:2012-10-29
  • 最后修改日期:2013-02-17
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  • 在线发布日期: 2013-03-15