Stawicki Stanislaw Peter, Schwab C William
Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Am Surg. 2008 Dec;74(12):1133-45.
Pancreatic injuries are rare, with penetrating mechanisms being causative in majority of cases. They can create major diagnostic and therapeutic challenges and require multiple diagnostic modalities, including multislice high-definition computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, ultrasonography, and at times, surgery and direct visualization of the pancreas. Pancreatic trauma is frequently associated with duodenal and other severe vascular and visceral injuries. Mortality is high and usually related to the concomitant vascular injury. Surgical management of pancreatic and pancreatic-duodenal trauma is challenging, and multiple surgical approaches and techniques have been described, up to and including pancreatic damage control and later resection and reconstruction. Wide surgical drainage is a key to any surgical trauma technique and access for enteral nutrition, or occasionally parenteral nutrition, are important adjuncts. Morbidity associated with pancreatic trauma is high and can be quite severe. Treatment of pancreatic trauma-related complications often requires a combination of interventional, endoscopic, and surgical approaches.
胰腺损伤较为罕见，大多数情况下由穿透性机制所致。它们会带来重大的诊断和治疗挑战，需要多种诊断方式，包括多层高清计算机断层扫描、磁共振胰胆管造影、内镜逆行胰胆管造影、超声检查，有时还需要手术以及直接观察胰腺。胰腺创伤常伴有十二指肠及其他严重的血管和内脏损伤。死亡率很高，通常与伴随的血管损伤有关。胰腺和胰十二指肠创伤的手术管理具有挑战性，已经描述了多种手术方法和技术，直至包括胰腺损伤控制以及后期的切除和重建。广泛的手术引流是任何手术创伤技术的关键，肠内营养通路，或偶尔的肠外营养通路是重要的辅助手段。与胰腺创伤相关的发病率很高，且可能相当严重。胰腺创伤相关并发症的治疗通常需要介入、内镜和手术方法相结合。
