目的总结胰腺损伤诊断和治疗的经验。方法回顾性分析我科2005年12月至2010年6月期间收治的35例胰腺损伤患者的临床资料。结果男32例，女3例; 年龄11～47岁，平均29岁。损伤程度: Ⅰ、Ⅱ级20例，Ⅲ级12例，Ⅳ级2例，Ⅴ级1例。根据病史、临床症状、血清淀粉酶、腹腔穿刺液淀粉酶检测、B超、CT等诊断。4例行非手术治疗; 31例行手术治疗，其中16例行胰腺被膜切开、清创、冲洗、引流，6例行损伤胰腺远端切除，6例行近端缝合、远端空肠Roux-en-Y吻合，2例胰腺主胰管吻合放置支撑管经空肠外引流，1例胰头部严重毁损行胰十二指肠切除术。术前明确诊断24例，术中明确诊断11例。本组死亡5例，均为胰腺复合伤，其中1例肠系膜上动脉损伤合并实质脏器损伤术后24 h死亡，4例胰腺严重毁损，术前抗休克后术中探查见胰腺损伤合并2个以上脏器损伤，术后肝、肾功能衰竭，经抢救无效死亡。治愈30例。结论胰腺损伤的术前诊断率较低，围手术期应积极剖腹探查弥补术前不足，外科治疗要根据损伤分级采取个体化方案，贯彻损伤控制性外科理念，不宜盲目扩大手术。
Objective To optimize image quality and radiation dose of infant chest digital radiography and to explore feasibility of reducing tube voltage and adjusting according to infant chest area. Methods 0 to 3-year-old infants were randomly divided into two average groups of 0- and 1-3 year-old, and then each age group was randomly assigned to optimization and control groups in digital radiography. Measurement of radiation dose used dose area product (DAP). Mean DAP between groups was compared by using t test, and the image quality of optimization was compared by rank sum test. Results A total of 400 cases of 0 to 3-year-old infants were identified, and finally 391 cases of infants anteroposterior chest image were included, including 196 cases in the optimization group (0-years: n=91; 1-3 years: n=105) and 195 cases in the control group (0-years: n=103; 1-3 years: n=92). The results showed: there were significant differences in the mean DAP in 0-years, 1-3 years and total infants between the optimization group and the control group (all P valuelt;0.05). The DAP of the optimization group was lower, and reduction of DAP was approximately 21.6% compared to the control subject. The Wilcoxon signed-rank test showed the difference of subjective evaluation of image quality was significantly different (P=0.000). High-quality image of the optimization group increased approximately 43.9% more than control subject. Conclusion Reducing tube voltage and adjusting according to infants chest area can not only reduce the radiation dose but also improve image quality in digital radiography.