Thanh L N, Duchmann J C, Latrive J P, That B T, Huguier M
Hôpital Viet Duc, Hanoï, Vietnam.
Chirurgie. 1999 Apr;124(2):165-70. doi: 10.1016/s0001-4001(99)80060-9.
To report three cases of neck pancreatic disruption caused by blunt abdominal trauma and to emphasize the advantages of conservative surgery with internal drainage.
In two cases, one with hemoperitoneum, and the other with intraperitoneal fluid collection with 1,323 U/mL of amylase, laparotomy showed a complete disruption of the neck of the pancreas. The pancreatic head side was sutured whereas the left side was anastomosed to a Roux-en-Y jejunal loop. The clinical results were good at 8 and 6 months after surgery, respectively. For the third patient, a pancreatic trauma (which was suspected on a CT. Scan), was not confirmed at laparotomy. In the postoperative course, the amount of fluid drainage was important and the endoscopic retrograde pancreatography (ERCP) showed a disruption of the neck of the pancreas. An endoprosthesis was placed into the duct of Wirsung. Three months later, the patient complained of pain, and a migration of the prosthesis was detected by X-ray examination. It was not possible to place another endoprosthesis because of a stenosis of the duct. A resection of the neck of the pancreas was performed, the cephalic side was sutured and the left side anastomosed to the posterior gastric wall. Eight months after surgery, the clinical result was good and glycemia was normal.
In blunt abdominal trauma, if a pancreas injury is suspected upon clinical presentation an ERCP, or moreover a magnetic resonance imaging, is indicated. When there is no disruption of the Wirsung duct, a simple peritoneal drainage should suffice. In cases with partial disruption, an endoprosthesis may give good results. In patients with a complete disruption, as in the three cases reported, a suture of the head side of the pancreas, and an internal drainage of the left side with a Roux-en-Y jejunal loop (or more easily with the stomach), are indicated.
报告3例钝性腹部创伤所致颈部胰腺破裂病例，并强调保守性手术及内引流的优势。
2例患者，1例有腹腔积血，另1例腹腔积液且淀粉酶水平为1323 U/mL，剖腹探查显示胰腺颈部完全破裂。胰头侧予以缝合，左侧与空肠袢行Roux-en-Y吻合。术后8个月和6个月临床结果均良好。第3例患者，胰腺损伤（CT扫描怀疑有损伤），剖腹探查未得到证实。术后病程中，引流量较多，内镜逆行胰胆管造影（ERCP）显示胰腺颈部破裂。在主胰管内置入内支架。3个月后，患者诉疼痛，X线检查发现支架移位。因导管狭窄无法再置入内支架。遂行胰腺颈部切除术，胰头侧缝合，左侧与胃后壁吻合。术后8个月，临床结果良好，血糖正常。
在钝性腹部创伤中，如果临床表现怀疑胰腺损伤，建议行ERCP或磁共振成像检查。当主胰管未破裂时，单纯腹腔引流即可。对于部分破裂的病例，内支架置入可能效果良好。对于完全破裂的患者，如本文报道的3例病例，建议缝合胰腺头部，左侧与空肠袢（或更简便地与胃）行内引流。
