影像学检查在儿童钝性腹部创伤所致胰腺损伤中的作用。

The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children.

作者信息

Bosboom D, Braam A W E, Blickman J G, Wijnen R M H

机构信息

Department of Radiology, University Medical Center St Radboud, Postbus 9101, Route 667, 6500 HB Nijmegen, The Netherlands.

出版信息

Eur J Radiol. 2006 Jul;59(1):3-7. doi: 10.1016/j.ejrad.2006.03.010. Epub 2006 Jun 15.

DOI:10.1016/j.ejrad.2006.03.010

PMID:16781837

Abstract

BACKGROUND

The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma.

METHOD

Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma.

RESULTS

Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts.

CONCLUSION

Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions.

摘要

背景

影像学检查在创伤性胰腺损伤治疗方案的选择中所起的作用仍不明确。本研究旨在深入了解影像学检查对我院收治的16岁及以下因钝性腹部创伤导致胰腺损伤患儿的作用。

方法

回顾性分析我院1975年至2003年间收治的所有因钝性腹部创伤导致胰腺损伤患儿的影像学及临床病历资料。

结果

34例年龄在3至14岁之间的患儿因创伤性胰腺损伤入院。最初，33例患儿因胰腺损伤接受保守治疗，仅1例患儿立即接受了胰腺Roux-y胰空肠吻合术。另外5例患儿因其他原因接受了急诊手术。总体而言，5例患儿经CT扫描或剖腹手术证实为胰腺横断伤。1例患儿为胰腺血肿，28例为胰腺挫伤。共有15例患儿出现假性囊肿（44%），其中9例自行消退，6例接受了干预治疗。所有患儿均无残留并发症，也无死亡病例。两名放射科医生对11份可用的CT图像进行了独立重新评估。放射科医生A诊断出5例3级胰腺损伤（胰管远端横断），放射科医生B诊断出4例（匹配率80%）；1级损伤分别诊断出6例和1例（匹配率15%）。对19例患儿进行了超声检查，共进行了82次随访检查，主要用于假性囊肿的随访。