Tyburski J G, Dente C J, Wilson R F, Shanti C, Steffes C P, Carlin A
Department of Surgery, Detroit Receiving Hospital, Wayne State University School of Medicine, Michigan 48201, USA.
Am Surg. 2001 Mar;67(3):227-30; discussion 230-1.
Patients with pancreatic and/or duodenal trauma often have a high incidence of infectious complications. In this study we attempted to find the most important risk factors for these infections. A retrospective review of the records of 167 patients seen over 7 years (1989 through 1996) at an urban Level I trauma center for injury to the duodenum and/or pancreas was performed. Fifty-nine patients (35%) had isolated injury to the duodenum (13 blunt, 46 penetrating), 81 (49%) had isolated pancreatic trauma (18 blunt, 63 penetrating), and 27 (16%) had combined injuries (two blunt, 25 penetrating). The overall mortality rate was 21 per cent and the infectious morbidity rate was 40 per cent. The majority of patients had primary repair and/or drainage as treatment of their injuries. Patients with pancreatic injuries (alone or combined with a duodenal injury) had a much higher infection rate than duodenal injuries. The patients with duodenal injuries had significantly lower penetrating abdominal trauma indices, number of intra-abdominal organ injuries, and incidence of hypothermia. On multivariate analysis independent factors associated with infections included hypothermia and the presence of a pancreatic injury. Although injuries to the pancreas and duodenum often coexist it is the pancreatic injury that contributes most to the infectious morbidity.
胰腺和/或十二指肠创伤患者感染性并发症的发生率往往较高。在本研究中，我们试图找出这些感染最重要的危险因素。对一家城市一级创伤中心7年（1989年至1996年）间收治的167例十二指肠和/或胰腺损伤患者的记录进行了回顾性分析。59例（35%）患者为单纯十二指肠损伤（钝性伤13例，穿透性伤46例），81例（49%）为单纯胰腺创伤（钝性伤18例，穿透性伤63例），27例（16%）为合并伤（钝性伤2例，穿透性伤25例）。总死亡率为21%，感染发病率为40%。大多数患者接受了一期修复和/或引流治疗损伤。胰腺损伤患者（单独或合并十二指肠损伤）的感染率远高于十二指肠损伤患者。十二指肠损伤患者的穿透性腹部创伤指数、腹内脏器损伤数量和体温过低发生率显著较低。多因素分析显示，与感染相关的独立因素包括体温过低和胰腺损伤的存在。虽然胰腺和十二指肠损伤常同时存在，但胰腺损伤对感染发病率的影响最大。
