Vasquez J C, Coimbra R, Hoyt D B, Fortlage D
Department of Surgery, Division of Trauma, University of California, UCSD Medical Center, 200 W. Arbor Dr., San Diego, CA 92103-8896, USA.
Injury. 2001 Dec;32(10):753-9. doi: 10.1016/s0020-1383(01)00099-7.
We present our experience in the management of penetrating pancreatic injuries, focusing on factors related to complications and death.
Retrospective trauma registry-based analysis of 62 consecutive patients with penetrating pancreatic injuries during an 11-year period. Overall injury severity was assessed by the injury severity score (ISS) and the penetrating abdominal trauma index (PATI). Pancreatic injuries were graded according to the American Association for the Surgery of Trauma (AAST) Organ Injury Scaling (OIS). Complications were characterised using standardised definitions. Mortality was recorded as early (within 48 h after admission) and late (after 48 h).
Thirty patients suffered gunshot wounds and 24 had grade I pancreatic injuries. Shotgun and gunshot wounds were more destructive than stab wounds (higher PATI, number of intraabdominal injuries and mortality). Seventeen patients died. Most deaths occurred within 1 h after admission due to massive bleeding and severe associated injuries. Only one death was potentially related to the pancreatic injury. Mortality rate also correlated with pancreatic injury grading. Sixty-one patients had associated intraabdominal injuries. Combined pancreaticoduodenal injuries were present in 13 patients, and five died. Simple drainage was the most common procedure performed. Pancreas-related complications were found in 12 out of 47 patients who survived more than 48 h; intraabdominal abscess (n=7) that was associated with colon injuries, and pancreatic fistula (n=5).
An approach based on injury grade and location is advised. Routine drainage is recommended; distal resection is indicated in the presence of main duct injury, and the management of severe injuries will be tailored according to the overall physiologic status, presence of associated injuries, and duodenal viability. Morbidity and mortality is mainly due to associated injuries.
我们介绍了穿透性胰腺损伤的治疗经验，重点关注与并发症和死亡相关的因素。
基于创伤登记系统对11年间连续收治的62例穿透性胰腺损伤患者进行回顾性分析。通过损伤严重程度评分（ISS）和穿透性腹部创伤指数（PATI）评估总体损伤严重程度。根据美国创伤外科学会（AAST）器官损伤分级（OIS）对胰腺损伤进行分级。使用标准化定义对并发症进行特征描述。将死亡率记录为早期（入院后48小时内）和晚期（48小时后）。
30例患者为枪伤，24例为Ⅰ级胰腺损伤。霰弹枪伤和枪伤比刺伤更具破坏性（PATI更高、腹内损伤数量更多、死亡率更高）。17例患者死亡。大多数死亡发生在入院后1小时内，原因是大量出血和严重的合并伤。只有1例死亡可能与胰腺损伤有关。死亡率也与胰腺损伤分级相关。61例患者有腹内合并伤。13例患者存在胰十二指肠联合损伤，5例死亡。单纯引流是最常见的手术方式。在47例存活超过48小时的患者中，12例出现胰腺相关并发症；与结肠损伤相关的腹腔内脓肿（n = 7）和胰瘘（n = 5）。
建议采用基于损伤分级和部位的治疗方法。推荐常规引流；主胰管损伤时应行远端切除术，严重损伤的处理将根据整体生理状态、合并伤情况和十二指肠的活力进行调整。发病率和死亡率主要归因于合并伤。
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