Gomez M-A, Besson M, Scotto B, Roger R, Alison D
Département de Radiologie Adultes Hôpital Trousseau, CHU de Tours, 37044 Tours.
J Radiol. 2004 Apr;85(4 Pt 1):414-7. doi: 10.1016/s0221-0363(04)97602-0.
Pancreatic injuries caused by blunt trauma are unusual but associated with a high morbidity and a high mortality because of a delay in diagnosis. Clinical and laboratory findings are non-specific. Accurate grading of blunt pancreatic injury with identification of pancreatic duct disruption helps to define practical treatment guidelines. Computed tomography does not allow direct visualization of the pancreatic duct and may result in low accuracy for the detection of ductal injury. Endoscopic retrograde pancreatography is the "gold standard" but invasive (3-5% complication rate, mainly pancreatitis) and may not be possible in up to 30% of patients, or requested after surgery. Endoscopic retrograde pancreatography may be used as a therapeutic modality (stenting of the main pancreatic duct). Magnetic resonance cholangiopancreatography is non invasive and preliminary results are promising. Magnetic resonance cholangiopancreatography detects pseudocysts, has multiplanar capability and complemented with conventional MR imaging allows evaluation of the pancreatic parenchyma.
钝性创伤所致胰腺损伤并不常见,但由于诊断延迟,其发病率和死亡率都很高。临床和实验室检查结果不具特异性。准确分级钝性胰腺损伤并识别胰管破裂有助于制定切实可行的治疗指南。计算机断层扫描无法直接观察胰管,对检测胰管损伤的准确性可能较低。内镜逆行胰胆管造影是“金标准”,但具有侵入性(并发症发生率为3 - 5%,主要为胰腺炎),高达30%的患者可能无法进行,或在术后才要求进行。内镜逆行胰胆管造影可作为一种治疗手段(主胰管支架置入)。磁共振胰胆管造影是非侵入性的,初步结果很有前景。磁共振胰胆管造影可检测假性囊肿,具有多平面成像能力,与传统磁共振成像相结合可评估胰腺实质。