中国普外基础与临床杂志

中国普外基础与临床杂志

保脾胰体尾切除在小儿胰腺损伤中的应用评价

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目的 探讨保脾胰体尾切除在小儿胰腺体尾部损伤手术中的安全性和可行性。 方法 回顾性分析 2012 年 1 月至 2017 年 7 月期间在桂林医学院第二附属医院行保脾胰体尾切除的 10 例严重胰腺体尾部损伤患儿的临床资料。观察患儿术中及术后的情况,包括手术时间、术中出血量、术后血小板计数及围手术期并发症发生情况。 结果 10 例患儿均成功地施行了保留脾脏的胰腺体尾切除术。手术时间中位数为 3 h(2~6 h),平均术中出血量为 100 mL(50~300 mL);术后血小板计数的中位数为 175×109/L(75×109/L~260×109/L)。术后发生胰瘘2 例,膈下感染和肺部感染各 1 例,均给予对症处理后治愈。术后所有患者均在门诊完成随访,随访时间为 4~60 个月,中位数为 30 个月。术后每 3 个月复查腹部超声及血常规,脾脏血供、形态及结构均无异常,血小板计数均波动在正常范围之内。随访期间,无任何患儿因脾功能减退而导致凶险性感染。 结论 保脾胰体尾切除在小儿胰腺体尾部损伤的应用中是安全和有效的手术方式。

Objective To explore the safety and feasibility of spleen-preserving distal pancreatectomy for children with distal pancreatic injures. Methods Clinical data of 10 patients with severe distal pancreatic injures in The Second Affiliated Hospital of Guilin Medical University from January 2012 to July 2017 were retrospectively analyzed. The intraoperative and postoperative situation including operation time, intraoperative blood loss, postoperative blood platelet count, and perioperative complications were observed. Results All the 10 patients underwent spleen-preserving distal pancreatectomy successfully. The median operation time was 3 h (2–6 h), the median intraoperative blood loss was100 mL (50–300 mL), the postoperative blood platelet count ranged from 75×109/L to 260×109/L with the median postoperative blood platelet count was 175×109/L. Two patients suffered from pancreatic leakage, one patient suffered from subphrenic infection, and one patient suffered from pulmonary infection. All patients suffered from complication recovered after symptomatic treatments. All patients were followed up in the outpatient department, the follow-up time was 4–60 months with a median of 30 months. Reexamination of abdominal ultrasound and blood routine (every 3 months after surgery) showed that, no abnormalities in blood supply, morphology, and structure of spleen, and platelet counts fluctuated within the normal range. During the follow-up period, none of the children suffered from severe infection due to hyposplenic function. Conclusion Spleen-preserving distal pancreatectomy is a safe and effective method for children with distal pancreatic injures.

关键词: 胰腺损伤; 儿童; 保脾胰体尾切除

Key words: pancreatic injury; children; spleen-preserving distal pancreatectomy

引用本文: 郭威, 张冲, 李桂鲜, 姚红兵, 吴嘉兴, 蒋建晖. 保脾胰体尾切除在小儿胰腺损伤中的应用评价. 中国普外基础与临床杂志, 2019, 26(2): 153-156. doi: 10.7507/1007-9424.201810038 复制

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