Đánh giá kết quả chẩn đoán và điều trị vỡ eo tụy

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Nguyên Hưng Thái

Ngôn ngữ: Vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam) 2023

Mô tả vật lý: 69-74

Bộ sưu tập: Metadata

ID: 408982

Thêm vào giỏ Liên kết toàn văn

Mô tả đặc điểm lâm sàng và cận lâm sàng của vỡ eo tụy. Đánh giá kết quả chẩn đoán và điều trị vỡ eo tụy. Đối tượng và phương pháp nghiên cứu (NC): + Nghiên cứu mô tả hồi cứu. + Tất cả những bệnh nhân (BN),không phân biệt tuổi,giới,được chẩn đoán vỡ eo tụy, được phẫu thuật và/hoặc điều trị tai BV Việt đức. + Thời gian: Từ năm 2012 đến năm 2017. Kết quả nghiên cứu: Có 24 bệnh nhân vỡ eo tụy được đưa vào NC bao gồm: 23 nam (95,8%), nữ 1 (4,2%), tuổi trung bình 30,2 ( từ 8 - 68), nguyên nhân vỡ eo tụy do tai nạn giao thông 16 BN (66,7%), tại nạn lao động 1 BN (4,1%), tai nạn sinh hoạt 7 BN (29,2%). Khám lâm sàng: 100% các bệnh nhân đều đau bụng, đau thượng vị 62,5%, đau dưới sườn trái 33,3%, đau dưới sườn phải 16,7%, đau hố chậu phải 4,1%, đau khắp bụng 33,3%, bụng chướng 83,3%. Xét nghiệm bạch cầu (BC) >
10.000/mm3 79,2%. Có 95,8% amylase máu tăng. Siêu âm phát hiện vỡ tụy 9/24 BN (37,5%), chụp cắt lớp vi tính (CLVT) phát hiện vỡ tụy 100% trong đó vỡ eo tụy đơn thuần là 70,8% còn lại là vỡ eo tụy phối hợp với vỡ thân, đuôi tụy. Mổ cấp cứu 66,7%, mổ phiên 12,5%, điều trị nội 20,8%. Mổ khâu diện vỡ đầu tụy nối thân, đuôi tụy ruột 57,9%, cắt eo thân đuôi tụy 15,8%, nối nang giả tụy-dạ dày 15,8%, còn lại là khâu cầm máu, làm sạch, dẫn lưu (2 bệnh nhân). Kết quả 84,2% hậu phẫu bình thường, ra viện, 1 BN apxe tồn dư chọc hút dưới siêu âm, 1 BN rò tụy (tiến triển thành nang tụy) mổ lại nối nang tụy dạ dày, 1 BN rò tụy giảm dần. Kết luận: - Vỡ eo tụy thường xảy ra do vật cứng tác động mạnh vào vùng thượng vị: Tai nạn sinh hoạt (đá bóng bị gối đập vào, thợ mộc - gỗ đập vào khi bào), do bạo lực (bị đánh) hoặc tai nạn giao thông (ghi đông xe đạp, xe máy...). - Nam giới trẻ tuổi chiếm tỷ lệ vỡ eo tụy cao: 23/24 trường hợp (95,8%), tuổi TB: 30,2, nhỏ nhất là 8 tuổi, lớn nhất là 68 tuổi. - Biểu hiện lâm sàng thường kín đáo: BN thường có mạch. HA ổn định, không sốt, đau bụng thượng vị 15/24 BN (62,5%), đau DST 8/24 BN (33,3%), đau khắp bụng 8/24 BN (33,3%), bụng chướng 20/24 BN (83,3%), cảm ứng phúc mạc: 8/24 BN (33,3%), Phản ứng thành bụng: 10/24 BN (41,7%). - Số lượng BC tăng >
10.000/mm3 19/24 BN (79,2%), Amylase máu tăng: 23/24 BN (95,8%). - Các phương pháp chẩn đoán hình ảnh: + Siêu âm: Dịch ổ bụng: 21/24 BN (87,5%), Dịch HCMN: 11/24 BN (45,8%), đường vỡ tụy: 9/24 BN (37,5%). + Chụp CLVT: Dịch ổ bụng 23/24 BN (95,8%), dịch HCMN 23/24 BN (95,8%), đường vỡ eo tụy: 24/24 (100,0%). + Tổn thương qua chụp CLVT: Vỡ eo tụy đơn thuần: 17/24 BN (70,5%), vỡ eo tụy phối hợp với vỡ thân-đuôi tụy: 7/24 BN (29,5%). - Các phương pháp xử trí: + Mổ cấp cứu: 16/24 BN (66,7%). + Mổ phiên: 3/24 BN (12,5%). + Điều tri nội: 5/24 BN (20,8%). + Các phương pháp mổ: Mổ khâu diện vỡ đầu tụy, nối thân-đuôi tụy-ruột cho kết quả tốt 11/19 BN (57,9%), hoặc cắt eo thân, đuôi tụy nếu tổn thương đụng dập, phần thân, đuôi tụy còn lại ngắn (<
6 cm): 3/19 BN (15,8%). Mổ làm sạch, dẫn lưu sẽ gây rò tụy kéo dài. + Điều trị nội khoa: Một số trường hợp tổn thương eo tụy có thể theo dõi và điều trị nội khoa: 5/24 BN (20,8%)., Tóm tắt tiếng anh, We reported our retrospective study aim at evaluating the clinical feature of blunt pancreatic neck injury and the result of its surgical and medical treatment. Patient and method: Restrospective study. + Time From 2012 to 2017. Result: There were 24 patients of blunt pancreatic neck injury were observed, male 23 patients (95,8%), female 1 patient (4,2%), the mean age: 30,2. The reason for pancreatic injury: traffic acident: 66,7%, labour accident: 4,1%, other: 29,2%. Clinic feature: abdominal pain: 100%, elevation of amylasemie: 95,8%. Ultrasonography only detected 37,5% pancreatic injury. Abdominal CTscan detected 100% of pancreatic injury. 66,7% of the patients were performed emergency operation, 12,5% were elective operation, observation and medical treatment were 20,8%. The surgical procedure included: 57,9% were sutured the proximal stump of pancreatic head and anastomosis pancreatico-jejunostomy of the distal stump (Roux en Y). 15,8% were peformed left pancreatectomy, 15,8% were performed pancretico-gastrostomy anastomosis of the pseudocyst of pancreas, 2 patients were performed drainage and necrosectomy. The complications: 1 had abscesses (Drainage under ultrasound), 2 had pancreatic fistulas (one had other operation pancreatic psuedocyst gastrostomy 3 months later, the other: the pancreatic fistulas stopped spontaneously by mediacal treatment). Conclusion: Blunt pancreatic neck injury are serious lesion due to traffic accident 66,7%, labour accident 4,1% and other accident 29,2%. The main symptoms were abdominal pain, raise of white cell and amylasemie. Computerzied tomography is the good choise for the diagnosis of blunt pancreatic injury (high precision). Abdominal surgery was the principal method for its treatment included: Left pancreatectomy, suture of the proximal pancreatic stump and anastomosis pancreatico-jejunostomy (the distal stump) or external drainage and pancreatic necrosectomy. We had no death post operation. The complications were mainly pancreatic fistulas with low proportion.

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