保脾胰体尾切除在小儿胰腺损伤中的应用评价
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摘要
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(every3 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.
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(every3 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.
引文
1 Klin B, Abu-Kishk I, Jeroukhimov I, et al. Blunt pancreatic trauma in children. Surg Today, 2011, 41(7):946-954.
2萧岗,任培土,鲁葆春.胰腺损伤58例诊治体会.肝胆胰外科杂志,2014, 26(2):154-156.
3 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.
4张隽开,谭广,罗海峰,等.双套管引流灌洗治疗胰腺手术后胰瘘:附33例报告.中国普通外科杂志,2014, 23(3):389-391.
5张俊晶,孟兴凯,李得溪,等.闭合性胰腺损伤诊疗现状.中华急诊医学杂志,2011,20(2):217-219.
6 Vasquez M, Cardarelli C, Glaser J, et al. The ABC's of pancreatic trauma:airway, breathing, and computerized tomography scan?Mil Med,2017,182(S1):66-71.
7刘续宝,熊俊杰,胰腺,等.胰腺及十二指肠损伤早期诊断.中国实用外科杂志,2015, 35(3):248-252.
8 Christodoulou DK, Tsianos EV. Role of endoscopic retrograde cholangiopancreatography in pancreatic diseases. World J Gastroenterol, 2010,16(38):4755-4761.
9 Mahajan A, Kadavigere R, Sripathi S, et al. Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas:a prospective study with systematic review. Injury, 2014,45(9):1384-1393.
10 Westgarth-Taylor C, Loveland J. Paediatric pancreatic trauma:a review of the literature and results of a multicentre survey on patient management. S Afr Med J, 2014, 104(11 Pt 2):803-807.
11 Englum BR, Gulack BC, Rice HE, et al. Management of blunt pancreatic trauma in children:review of the National Trauma Data Bank. J Pediatr Surg, 2016, 51(9):1526-1531.
12 Maeda K, Ono S, Baba K, et al. Management of blunt pancreatic trauma in children. Pediatr Surg Int, 2013,29(10):1019-1022.
13 Lahiri R, Bhattacharya S. Pancreatic trauma. Ann R Coll Surg Engl,2013, 95(4):241-245.
14 Kottapalli DC, Devashetty S, Suryanarayana VR, et al. Complete pancreatic duct disruption in an isolated pancreatic injury:successful endoscopic management. Oxf Med Case Reports, 2016,2016(3):44-46.
15 Rosenfeld EH, Vogel AM, Klinkner DB, et al. The utility of ERCP in pediatric pancreatic trauma. J Pediatr Surg, 2018, 53(1):146-151.
16丁威威,王凯,刘宝晨.胰腺外伤单中心136例诊治报告.中国实用外科杂志,2018, 38(7):782-785.
17 Peck GL, Blitzer DN, Bulauitan CS, et al. Outcomes after distal pancreatectomy for trauma in the Modern Era. Am Surg, 2016,82(6):526-532.
18 Chanis W, Pataki I, Mohos G, et al. Organ saving intervention for pancreatic trauma. Magy Seb, 2016,69(3):113-116.
19戴睿武.胰腺损伤救治中的几个重要问题.创伤外科杂志,2017,19(4):241-243.
20 Santos-Antunes J, Moutinho-Ribeiro P, Macedo G. Endoscopic management of late complication of blunt traumatic total pancreatic transection. Rev Esp Enferm Dig, 2016, 108(11):735-736.
21 Ciftci F, Abdulrahman I, Ibrahimoglu F, et al. Early-stage quantitative analysis of the effect of laparoscopic versus conventional inguinal hernia repair on physical activity. Chirurgia(Bucur), 2015,110(5):451-456.
22刘志伟,蔡守旺,何蕾.创伤性胰腺损伤诊断治疗的临床分析.中华肝胆外科杂志,2012, 18(9):676-679.
23李长春,王珊,李晓庆,等.腹部闭合伤致儿童胰腺外伤的诊治探讨.中华小儿外科杂志,2009, 30(4):231-234.
24王义涛,齐浩龙,郭涛,等.胰体尾切除术后胰瘘的防治.腹部外科,2014,27(5):377-380.
25 Malde DJ, Khan A, Prasad KR, et al. Inferior vena cava resection with hepatectomy:challenging but justified. HPB(Oxford), 2011,13(11):802-810.
26蒋国庆,柏斗胜,钱建军,等.保留脾脏及供应血管胰体尾切除治疗胰腺断裂伤18例报道.国际外科学杂志,2014, 41(1):29-31.
27曹金铎.脾脏外科.北京:人民卫生出版社,2000:19-68.
28陈国玉,吴文溪.外科学.北京:科学出版社,2002:570-572.
29 Shoup M, Brennan MF, McWhite K, et al. The value of splenic preservation with distal pancreatectomy. Arch Surg, 2002, 137(2):164-168.
2萧岗,任培土,鲁葆春.胰腺损伤58例诊治体会.肝胆胰外科杂志,2014, 26(2):154-156.
3 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.
4张隽开,谭广,罗海峰,等.双套管引流灌洗治疗胰腺手术后胰瘘:附33例报告.中国普通外科杂志,2014, 23(3):389-391.
5张俊晶,孟兴凯,李得溪,等.闭合性胰腺损伤诊疗现状.中华急诊医学杂志,2011,20(2):217-219.
6 Vasquez M, Cardarelli C, Glaser J, et al. The ABC's of pancreatic trauma:airway, breathing, and computerized tomography scan?Mil Med,2017,182(S1):66-71.
7刘续宝,熊俊杰,胰腺,等.胰腺及十二指肠损伤早期诊断.中国实用外科杂志,2015, 35(3):248-252.
8 Christodoulou DK, Tsianos EV. Role of endoscopic retrograde cholangiopancreatography in pancreatic diseases. World J Gastroenterol, 2010,16(38):4755-4761.
9 Mahajan A, Kadavigere R, Sripathi S, et al. Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas:a prospective study with systematic review. Injury, 2014,45(9):1384-1393.
10 Westgarth-Taylor C, Loveland J. Paediatric pancreatic trauma:a review of the literature and results of a multicentre survey on patient management. S Afr Med J, 2014, 104(11 Pt 2):803-807.
11 Englum BR, Gulack BC, Rice HE, et al. Management of blunt pancreatic trauma in children:review of the National Trauma Data Bank. J Pediatr Surg, 2016, 51(9):1526-1531.
12 Maeda K, Ono S, Baba K, et al. Management of blunt pancreatic trauma in children. Pediatr Surg Int, 2013,29(10):1019-1022.
13 Lahiri R, Bhattacharya S. Pancreatic trauma. Ann R Coll Surg Engl,2013, 95(4):241-245.
14 Kottapalli DC, Devashetty S, Suryanarayana VR, et al. Complete pancreatic duct disruption in an isolated pancreatic injury:successful endoscopic management. Oxf Med Case Reports, 2016,2016(3):44-46.
15 Rosenfeld EH, Vogel AM, Klinkner DB, et al. The utility of ERCP in pediatric pancreatic trauma. J Pediatr Surg, 2018, 53(1):146-151.
16丁威威,王凯,刘宝晨.胰腺外伤单中心136例诊治报告.中国实用外科杂志,2018, 38(7):782-785.
17 Peck GL, Blitzer DN, Bulauitan CS, et al. Outcomes after distal pancreatectomy for trauma in the Modern Era. Am Surg, 2016,82(6):526-532.
18 Chanis W, Pataki I, Mohos G, et al. Organ saving intervention for pancreatic trauma. Magy Seb, 2016,69(3):113-116.
19戴睿武.胰腺损伤救治中的几个重要问题.创伤外科杂志,2017,19(4):241-243.
20 Santos-Antunes J, Moutinho-Ribeiro P, Macedo G. Endoscopic management of late complication of blunt traumatic total pancreatic transection. Rev Esp Enferm Dig, 2016, 108(11):735-736.
21 Ciftci F, Abdulrahman I, Ibrahimoglu F, et al. Early-stage quantitative analysis of the effect of laparoscopic versus conventional inguinal hernia repair on physical activity. Chirurgia(Bucur), 2015,110(5):451-456.
22刘志伟,蔡守旺,何蕾.创伤性胰腺损伤诊断治疗的临床分析.中华肝胆外科杂志,2012, 18(9):676-679.
23李长春,王珊,李晓庆,等.腹部闭合伤致儿童胰腺外伤的诊治探讨.中华小儿外科杂志,2009, 30(4):231-234.
24王义涛,齐浩龙,郭涛,等.胰体尾切除术后胰瘘的防治.腹部外科,2014,27(5):377-380.
25 Malde DJ, Khan A, Prasad KR, et al. Inferior vena cava resection with hepatectomy:challenging but justified. HPB(Oxford), 2011,13(11):802-810.
26蒋国庆,柏斗胜,钱建军,等.保留脾脏及供应血管胰体尾切除治疗胰腺断裂伤18例报道.国际外科学杂志,2014, 41(1):29-31.
27曹金铎.脾脏外科.北京:人民卫生出版社,2000:19-68.
28陈国玉,吴文溪.外科学.北京:科学出版社,2002:570-572.
29 Shoup M, Brennan MF, McWhite K, et al. The value of splenic preservation with distal pancreatectomy. Arch Surg, 2002, 137(2):164-168.