Wind P, Tiret E, Cunningham C, Frileux P, Cugnenc P H, Parc R
Department of Alimentary Tract Surgery, Saint Antoine Hospital, AP-HP, Paris, France.
Am Surg. 1999 Aug;65(8):777-83.
Pancreatic trauma is associated with high morbidity and mortality. Treatment of this condition is controversial. This retrospective study aimed to evaluate the management of distal pancreatic trauma and its complications, assessing the role of endoscopic retrograde cholangiopancreatography (ERCP). The clinical course and surgical management of 38 patients with distal pancreatic trauma were analyzed in a university hospital in Paris, France. Twenty-five patients were referred after initial treatment elsewhere. As initial treatment, patients underwent external drainage (n = 25), pancreatic resection (n = 6), laparotomy alone (n = 5), and no surgery (n = 2). Nineteen patients with pancreatic duct injury and no pancreatic resection developed fistulae (n = 14) or pseudocysts (n = 5). Only four of these patients recovered without a subsequent pancreatic resection or internal drainage procedure. In the absence of duct injury, patients recovered without the need for pancreatic resection. ERCP was performed in 16 cases and provided critical information on duct status influencing surgical management. We conclude that the presence of pancreatic trauma duct injury is a major determinant of complications and outcome after pancreatic trauma. It is optimally managed by pancreatic resection. ERCP is valuable in providing a definitive diagnosis of duct injury, thereby directing treatment.
胰腺创伤与高发病率和死亡率相关。这种疾病的治疗存在争议。这项回顾性研究旨在评估胰腺远端创伤及其并发症的处理，评估内镜逆行胰胆管造影术（ERCP）的作用。在法国巴黎的一家大学医院分析了38例胰腺远端创伤患者的临床病程和手术处理情况。25例患者在其他地方接受初始治疗后转诊。作为初始治疗，患者接受了外引流（n = 25）、胰腺切除术（n = 6）、单纯剖腹手术（n = 5）以及未进行手术（n = 2）。19例胰腺导管损伤且未行胰腺切除术的患者出现了瘘（n = 14）或假性囊肿（n = 5）。这些患者中只有4例在未进行后续胰腺切除术或内引流手术的情况下康复。在没有导管损伤的情况下，患者无需进行胰腺切除术即可康复。16例患者进行了ERCP，其提供了有关导管状况的关键信息，影响了手术处理。我们得出结论，胰腺创伤导管损伤的存在是胰腺创伤后并发症和预后的主要决定因素。通过胰腺切除术可实现最佳处理。ERCP在明确导管损伤诊断从而指导治疗方面具有重要价值。
