儿童胰腺损伤的处理：手术还是观察。
The management of pancreatic injuries in children: operate or observe.
机构信息
Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
出版信息
J Pediatr Surg. 2011 Jun;46(6):1140-3. doi: 10.1016/j.jpedsurg.2011.03.041.
PURPOSE
The critical management decision in pediatric pancreatic injuries involves whether or not to operate on patients with grade II or III injuries. Because of the rarity of these injuries, no one hospital cares for enough patients to determine the outcome of this decision. Given this, the American Pediatric Surgical Association accrued a series of patients with pancreatic injuries from the members of its Trauma Committee.
METHODS
A retrospective review of concurrent pancreatic injuries from 9 level 1 pediatric trauma centers was performed.
RESULTS
Data on 131 children were submitted. Forty-three patients suffered grade II or grade III injuries. Twenty patients underwent an operation, and 23 were observed. Patients who underwent an operation had an average length of stay of 16.1 days compared with 14.2 days. Two in the operative group received total parenteral nutrition compared with 12 in the nonoperative group. Eight in the nonoperative group developed a pseudocyst compared with 3 in the operative group.
CONCLUSIONS
Children with grade II or grade III pancreatic injuries managed nonoperatively had a higher rate of pseudocyst, lower rate of reoperation, and a comparable length of stay compared with those who underwent surgery. These data will be used to help design a prospective study of pancreatic injury management.
目的
小儿胰腺损伤的关键管理决策涉及是否对 II 级或 III 级损伤的患者进行手术。由于这些损伤较为罕见，没有一家医院能够治疗足够数量的患者来确定这一决策的结果。鉴于此，美国小儿外科学会从其创伤委员会的成员那里收集了一系列胰腺损伤患者的资料。
方法
对 9 个 1 级儿科创伤中心同时发生的胰腺损伤进行了回顾性分析。
结果
提交了 131 名儿童的数据。43 名患者患有 II 级或 III 级损伤。20 名患者接受了手术，23 名患者接受了观察。手术组的平均住院时间为 16.1 天，而观察组为 14.2 天。手术组中有 2 人接受了全胃肠外营养，而观察组中有 12 人。观察组中有 8 人发生假性囊肿，而手术组中有 3 人。
结论
非手术治疗 II 级或 III 级胰腺损伤的儿童发生假性囊肿的几率较高，再次手术的几率较低，住院时间与手术组相当。这些数据将用于帮助设计胰腺损伤管理的前瞻性研究。
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