摘要
目的回顾总结泌尿外科腹腔镜手术中胰腺损伤的处理经验。方法从2003年6月～2008年8月,我科共施行各类上尿路或肾上腺腹腔镜手术395例,其中胰腺损伤4例,发生率约1%。男性2例,女性2例,平均年龄45.3岁(32～76岁)。4例胰腺损伤均发生于左侧,其中2例为左肾癌根治术,2例为肾上腺肿瘤。损伤部位均位于胰尾部,其中横断伤2例,撕裂伤2例。1例采用开放手术处理胰腺断面,其余3例采用腔镜钛夹或endo-GIA夹闭胰尾或分支胰管,创面喷洒止血粉,留置引流管。术后常规禁食、胃肠减压、静脉滴注生长抑素以及静脉高营养等。结果4例患者术后平均血、尿和引流液淀粉升高,分别为(648±236)U、(1278.6±368.4)U和(1368.5±428.2)U。除1例患者开放手术后出现短暂高热和血白细胞升高外,其余患者恢复顺利。平均引流管留置时间14.2天(8～26天),平均住院24.6天(13～34天)。3～6个月后随访未发现胰腺异常。结论泌尿外科腹腔镜手术导致的胰腺损伤主要发生于尾部。术中及早发现和妥善处理是确保良好预后的关键。损伤严重者应及时采用开放或endo-GIA夹闭胰尾,保守治疗适用于轻微的胰管分支损伤或挫伤。
Objective To summarize the management experiences of pancreatic injuries during laparoscopic urologic surgery. Methods From June 2003 to August 2008, 395 laparoscopic operations for upper urinary or adrenal diseases were performed. 4 cases of pancreatic injuries which all occurred in left side introperiotoneal procedures were identified with the incidence of 1%. 2 men and 2women were involved with the mean age of 45.3 （range 32 -76y）. 2 injuries occurred during left radical nephrectomy and 2 during left adrenalectomy. All the injuries located at tail of pancreas with transaction injuries in 2 cases, and mild laceration in 2 cases. Only 1 case had received open surgery for pancreatic debridement, another 3 cases had received clamp and endo - GIA occlusion laparoscopically with local styptic powder aspersing and drainage. Absolute diet, gastrointestinal decompression, ,transvenous - use of Somatostatin and hyperalimentation were given routinely. Results The mean blood , urine and drainage fluid diastase that were （648 ± 136） U, （ 1278.6 ± 368.4） U and （ 1368.5 ±428.2） U respectively elevated in all 4 cases postoperatively. Only 1 case had high fever and blood WBC after operation. The mean drainage and hospital stay was 14.2 and 24.6 days. No sequelae was found. Conclusion The tail of pancreas is the most predilecting location of pancreatic injury in laparoscopic urological surgery. The key of ensuring a good prognosis is early detection and suitable management. A severe laceration of the main excretory pancreatic duct need a open surgical management, conservative managements are suitable for a small tear and mild contusion of pancreas.
出处
《医学研究杂志》
2009年第5期77-79,共3页
Journal of Medical Research
关键词
腹腔镜
泌尿外科
胰腺损伤
Pancreatic injury
Laparoscopy
Urology
