Cerwenka H, Bacher H, El-Shabrawi A, Kornprat P, Lemmerer M, Portugaller H R, Mischinger H J
Department of Visceral Surgery, Medical University of Graz, Austria.
Hepatogastroenterology. 2007 Mar;54(74):581-4.
BACKGROUND/AIMS: Diagnosis of pancreatic trauma and its complications may be difficult due to non-specific signs and symptoms and treatment recommendations are not unequivocal.
Clinical data of a series of 47 patients with pancreatic trauma were analyzed; most of them were polytraumatized and treated by an interdisciplinary team.
The most common causes were traffic accidents and sport injuries with 66% and 15%, respectively. Concomitant injuries were seen in 96% (nonpancreatic intra-abdominal injuries 85% including spleen 38% and liver 34%, extra-abdominal injuries 70%). Concomitant liver injuries were treated conservatively in 31% and operatively in 69% (including hepatic packing in 38%). Concomitant splenic injuries were usually very severe and could be managed conservatively in only 11%. All patients with pancreatic injuries grade III, IV or V (17%) according to the American Association of Surgical Trauma Classification required surgery, endoscopic treatment or interventional radiology. The most common posttraumatic complications were necrotizing pancreatitis (15%), pseudocyst formation (9%), abscesses (6%) and fistulas (4%).
The status of the pancreatic duct is the crucial point for management of pancreatic trauma and should be assessed as early as possible. Treatment has to be tailored to the individual situation, especially in patients with severe concomitant injuries or prolonged course.
背景/目的：由于胰腺创伤及其并发症的体征和症状不具特异性，其诊断可能存在困难，且治疗建议也不明确。
分析了47例胰腺创伤患者的临床资料；其中大多数患者为多发伤，由多学科团队进行治疗。
最常见的病因是交通事故和运动损伤，分别占66%和15%。96%的患者存在合并伤（非胰腺腹部内损伤85%，包括脾脏损伤38%和肝脏损伤34%；腹部外损伤70%）。31%的合并肝脏损伤患者采用保守治疗，69%采用手术治疗（其中38%采用肝脏填塞术）。合并脾脏损伤通常非常严重，仅11%可采用保守治疗。根据美国外科创伤协会分类，所有III级、IV级或V级胰腺损伤患者（17%）均需要手术、内镜治疗或介入放射学治疗。最常见的创伤后并发症为坏死性胰腺炎（15%）、假性囊肿形成（9%）、脓肿（6%）和瘘管（4%）。
胰管状况是胰腺创伤治疗的关键，应尽早评估。治疗必须根据个体情况进行调整，尤其是对于合并严重损伤或病程较长的患者。
