Division of Trauma and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Curr Opin Crit Care. 2011 Dec;17(6):613-7. doi: 10.1097/MCC.0b013e32834cd374.
In this study we present a concise review of the evolving management of traumatic injury to the pancreas, including diagnostic approaches and options for operative and nonoperative intervention.
New diagnostic adjuncts can be used for the evaluation of injury to the pancreas and pancreatic duct. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) are used as diagnostic modalities for duct evaluation. ERCP can be therapeutic with sphincterotomy and/or stenting for duct disruption. Computed tomography scan is the initial imaging study of choice for pancreatic injury, but is also used for drainage of pancreatic abscesses or pseudocysts.
Nonoperative management of solid organ injuries is the recommended treatment in hemodynamically stable patients. This strategy is now being successfully applied to pancreatic injuries in specific situations. However, the mainstays of pancreatic injury remain the same. The identification of pancreatic duct injury is the top priority. Management includes distal resection, debridement, and closed suction drainage of pancreatic injuries.
本研究简要回顾了胰腺创伤的治疗进展，包括诊断方法以及手术和非手术干预的选择。
新的诊断辅助方法可用于评估胰腺和胰管损伤。磁共振胰胆管成像和内镜逆行胰胆管造影（ERCP）可用于胰管评估的诊断方式。ERCP 可通过括约肌切开术和/或支架置入术治疗胰管破裂。对于胰腺损伤，CT 扫描是首选的初始影像学检查方法，但也可用于引流胰腺脓肿或假性囊肿。
血流动力学稳定的患者推荐采用非手术治疗方法治疗实质性器官损伤。在某些特定情况下，这种策略现在已经成功应用于胰腺损伤。然而，胰腺损伤的主要治疗方法仍然不变。首要任务是确定是否存在胰管损伤。治疗方法包括胰腺损伤的远端切除、清创和闭式吸引引流。
