Ouaïssi Mehdi, Sielezneff Igor, Chaix Jean Baptiste, Mardion Remi Bon, Pirrò Nicolas, Berdah Stéphane, Emungania Olivier, Consentino Bernard, Cresti Silvia, Dahan Laetitia, Orsoni Pierre, Moutardier Vincent, Brunet C, Sastre Bernard
Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialité Médicale et Chirurgicale Hôpital Timone, Marseille, France.
Hepatogastroenterology. 2008 May-Jun;55(84):817-20.
BACKGROUND/AIMS: Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases.
From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7).
There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage.
Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.
背景/目的：钝性创伤导致的胰腺损伤并不常见。本研究的目的是评估一种简化的胰腺创伤处理方法，对于需要立即手术的患者，在复杂情况下进行引流，其他情况则进行胰腺切除术。
1986年1月至2006年12月，对40例需要立即手术的胰腺创伤患者进行了治疗。记录入院时的创伤机制、临床和实验室检查结果，并根据卢卡斯分类法对胰腺损伤进行分类。I期（n = 15）患者均进行了引流（100%），II期（n = 18）患者60%进行了脾胰切除术，40%进行了引流，IV期（n = 7）患者3例进行了胰十二指肠切除术，2例进行了十二指肠旷置并引流，2例进行了填塞。
患者中男性30例，女性10例，平均年龄29±13岁（15 - 65岁）。38例患者有多处创伤。总体而言，死亡率和总发病率分别为17%和65%，且随着卢卡斯胰腺创伤分期增加而升高。
对于伴有胰管损伤的远端损伤，建议行远端胰腺切除术；对于血流动力学稳定的患者，应进行诸如胰十二指肠切除术等复杂手术。
