胰腺创伤的范围及预后

Kantharia Chetan V, Prabhu R Y, Dalvi A N, Raut Abhijit, Bapat R D, Supe Avinash N

Department of Surgical Gastroenterology, Seth GS Medical College & KEM Hospital, Parel, Mumbai-12.

Trop Gastroenterol. 2007 Jul-Sep;28(3):105-8.

BACKGROUND AND AIMS

Pancreatic trauma is associated with high morbidity and mortality. Diagnosis is often difficult and surgery poses a formidable challenge.

METHOD

Data from 17 patients of pancreatic trauma gathered from a prospectively maintained database were analysed and the following parameters were considered: mode of injury, diagnostic modalities, associated injury, grade of pancreatic trauma and management. Pancreatic trauma was graded from I through IV, as per Modified Lucas Classification.

RESULTS

The median age was 39 years (range 19-61). The aetiology of pancreatic trauma was blunt abdominal trauma in 14 patients and penetrating injury in 3. Associated bowel injury was present in 4 cases (3 penetrating injury and 1 blunt trauma) and 1 case had associated vascular injury. 5 patients had grade I, 3 had grade II, 7 had grade III and 2 had grade IV pancreatic trauma. Contrast enhanced computed tomography scan was used to diagnose pancreatic trauma in all patients with blunt abdominal injury. Immediate diagnosis could be reached in only 4 (28.5%) patients. 7 patients responded to conservative treatment. Of the 10 patients who underwent surgery, 6 required it for the pancreas and the duodenum. (distal pancreatectomy with splenectomy-3, pylorus preserving pancreatoduodenectomy-1, debridement with external drainage-1, associated injuries-duodenum-1). Pancreatic fistula, recurrent pancreatitis and pseudocyst formation were seen in 3 (17.05%), 2 (11.7%) and 1 (5.4%) patient respectively. Death occurred in 4 cases (23.5%), 2 each in grades III and IV pancreatic trauma.

CONCLUSIONS

Contrast enhanced computed tomography scan is a useful modality for diagnosing, grading and following up patients with pancreatic trauma. Although a majority of cases with pancreatic trauma respond to conservative treatment, patients with penetrating trauma, and associated bowel injury and higher grade pancreatic trauma require surgical intervention and are also associated with higher morbidity and mortality.

背景与目的

胰腺创伤与高发病率和死亡率相关。诊断往往困难，手术也构成巨大挑战。

方法

分析了前瞻性维护数据库中收集的17例胰腺创伤患者的数据，并考虑了以下参数：损伤方式、诊断方法、合并损伤、胰腺创伤分级及治疗。根据改良卢卡斯分类法，胰腺创伤分为I至IV级。

结果

中位年龄为39岁（范围19 - 61岁）。胰腺创伤的病因是14例钝性腹部创伤和3例穿透伤。4例（3例穿透伤和1例钝性创伤）合并肠损伤，1例合并血管损伤。5例为I级胰腺创伤，3例为II级，7例为III级，2例为IV级胰腺创伤。所有钝性腹部损伤患者均采用增强CT扫描诊断胰腺创伤。仅4例（28.5%）患者能立即确诊。7例患者接受保守治疗有效。10例接受手术的患者中，6例因胰腺和十二指肠病变需要手术（3例行远端胰腺切除术加脾切除术，1例行保留幽门的胰十二指肠切除术，1例行清创加外引流术，1例因合并十二指肠损伤）。分别有3例（17.05%）、2例（11.7%）和1例（5.4%）患者出现胰瘘、复发性胰腺炎和假性囊肿形成。4例（23.5%）患者死亡，III级和IV级胰腺创伤各死亡2例。