Lin B-C, Liu N-J, Fang J-F, Kao Y-C
Department of Trauma & Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan Hsien, 333, Taiwan, Republic of China.
Surg Endosc. 2006 Oct;20(10):1551-5. doi: 10.1007/s00464-005-0807-0. Epub 2006 Aug 1.
Pancreatic stents can be used to treat a variety of acute and chronic pancreatic lesions. Sporadic successful trials in trauma patients have been reported. To our knowledge, however, a series with long-term follow-up has not previously been reported. We treated six patients in a 6-year period and report the long-term results.
From February 1999 to February 2005, six blunt-trauma patients with major pancreatic duct disruption were treated with pancreatic duct stent at a single trauma center. Assessment of injury severity and diagnosis were based on abdominal computed tomography (CT) and proved by endoscopic retrograde pancreatography (ERP), with chart review used to establish mechanism of injury, timing of ERP, and stent placement, as well as the long-term outcome.
Three of the six injuries were classified AAST grade III and three were grade IV; the interval to ERP with stent placement ranged from 8 hours to 22 days after the injury. One patient developed sepsis and died. One patient's stent could be removed early (52 days post-stenting) with mild ductal stricture, whereas the other four were complicated by severe ductal stricture that required repeated and prolonged stenting treatment. Removal of the stents was only possible in three of these four cases (at 12, 19, and 39 months, respectively), with stent dislodgment in the pancreatic duct occurring in another.
Stent therapy may avoid surgery in the acute trauma stage, and may be preserved as another choice for acute grade IV pancreatic injury. However, variant outcome and long-term ductal stricture reveal that the role of pancreatic duct stent is uncertain and may not be suitable for acute grade III pancreatic injury. However, it needs more clinical data to define the value in the acute blunt pancreatic duct injury.
胰管支架可用于治疗多种急慢性胰腺病变。已有关于创伤患者的零星成功试验报道。然而，据我们所知，此前尚未有长期随访系列报道。我们在6年期间治疗了6例患者，并报告长期结果。
1999年2月至2005年2月，在单一创伤中心对6例钝性创伤致主胰管断裂患者进行胰管支架治疗。损伤严重程度评估和诊断基于腹部计算机断层扫描（CT），并经内镜逆行胰胆管造影（ERP）证实，通过查阅病历确定损伤机制、ERP时间、支架置入情况以及长期结果。
6例损伤中3例为美国创伤外科学会（AAST）Ⅲ级，3例为Ⅳ级；受伤至行ERP并置入支架的时间间隔为8小时至22天。1例患者发生脓毒症并死亡。1例患者的支架可早期取出（支架置入后52天），有轻度导管狭窄，而其他4例则并发严重导管狭窄，需要反复长时间进行支架治疗。这4例中仅3例成功取出支架（分别在12、19和39个月时），另1例出现胰管内支架移位。
支架治疗可避免急性创伤期手术，可作为急性Ⅳ级胰腺损伤的另一种选择。然而，结果各异以及长期导管狭窄表明胰管支架的作用尚不明确，可能不适用于急性Ⅲ级胰腺损伤。不过，需要更多临床数据来明确其在急性钝性胰管损伤中的价值。
