Rogers Stanley J, Cello John P, Schecter William P
Surgical and Medical Services, San Francisco General Hospital, San Francisco, California, USA.
J Trauma. 2010 Mar;68(3):538-44. doi: 10.1097/TA.0b013e3181b5db7a.
: Pancreatic injury occurs in from 3% to 12% of patients with abdominal trauma. In many instances, a lack of impressive findings in the first 24 hours leads to a delay in diagnosis. Because pancreatic duct disruption is the major cause of traumatic pancreatitis, we evaluated our experience with endoscopic retrograde cholangiopancreatography (ERCP) in patients suspected of having of having pancreatic injury.
: We reviewed the medical records of 26 patients evaluated perioperatively by ERCP for suspected pancreatic duct injury. The examinations were performed in the endoscopy suite or radiography special procedures or operating rooms under direct fluoroscopic control using fiberoptic or videooptic duodenoscopes.
: Seventeen men and nine women with a mean age of 32.8 +/- 2.2 years suffered severe abdominal trauma. ERCP was performed in these patients a mean of 19 +/- 11.3 days after trauma. Seven patients underwent ERCP just before or at laparotomy. Eight of 26 (31%) patients were found to have intact pancreatic and bile ducts, whereas 18 (69%) patients had substantial findings unsuspected by pre-ERCP imaging. Nine of these 18 patients with documented ductal injury underwent endoscopic treatment alone without further surgical intervention, including pancreatic sphincterotomies and/or pancreatic ductal stenting.
: ERCP is feasible and strongly indicated in the care of many patients with pancreatic trauma. Patient care and overall surgical and hospital needs may be substantially impacted by the use of both diagnostic and therapeutic endoscopic retrograde colongiopancreatography.
腹部创伤患者中3%至12%会发生胰腺损伤。在许多情况下，最初24小时内缺乏明显症状会导致诊断延迟。由于胰管破裂是创伤性胰腺炎的主要原因，我们评估了对疑似胰腺损伤患者进行内镜逆行胰胆管造影（ERCP）的经验。
我们回顾了26例因疑似胰管损伤而接受ERCP围手术期评估患者的病历。检查在内镜室、放射科特殊检查室或手术室进行，在直接荧光透视控制下使用纤维或视频十二指肠镜。
17名男性和9名女性，平均年龄32.8±2.2岁，遭受严重腹部创伤。这些患者在创伤后平均19±11.3天接受ERCP检查。7例患者在剖腹手术前或手术时接受ERCP检查。26例患者中有8例（31%）胰胆管完整，而18例（69%）患者有ERCP检查前影像学未发现的明显病变。这18例有明确导管损伤的患者中有9例仅接受内镜治疗，未进行进一步手术干预，包括胰括约肌切开术和/或胰管支架置入术。
ERCP在许多胰腺创伤患者的治疗中是可行且强烈推荐的。诊断性和治疗性内镜逆行胰胆管造影的应用可能会对患者护理以及整体手术和医院需求产生重大影响。
