Čečka F, Asqar A, Jon B, Kočí J, Šubrt Z, Ferko A
Chirurgická klinika LF UK v Hradci Králové a FN Hradec Králové.
Acta Chir Orthop Traumatol Cech. 2012;79(5):455-8.
The aim of the study is to present our experience with the diagnosis and therapy of penetrating abdominal injury involving the pancreas caused by a gun shot.
The group included patients with gun-shot abdominal injuries involving the pancreas who were treated at the Department of Surgery and the Department of Emergency Medicine at the University Hospital Hradec Králové. The extent of pancreatic injury was assessed using the American Association for the Surgery of Trauma (AAST) classification. The factors evaluated included the timing of surgery, operative strategy, operative time, blood loss, post-operative complications with pancreatic fistulas in particular, and the length of hospital stay. Pancreatic fistula was assessed according to the ISGPF (International Study Group for Pancreatic Fistula). RESULTS During the period of study lasting 10 years, three patients with gun-shot abdominal injuries involving the pancreas were treated.
Pancreatic trauma due to a gun shot is a rare injury, but has also been reported in the Czech Republic. In any penetrating injury to the abdomen due to a gun shot, surgical exploration is always indicated and pancreatic trauma is usually found during the surgery. The first step in the procedure is to check all potential sources of bleeding because uncontrolled bleeding is the most frequent cause of intra-operative death. In a seriously injured patient, the technique of damage control surgery must be employed. After the major sources of bleeding have been checked, a thorough exploration of all abdominal organs should be performed to ascertain whether the main pancreatic duct has not been injured and, if so, in which part of the pancreas and to what extent. The correct classification of pancreatic injury according to the AAST is necessary to indicate appropriate therapy. Exploration for injury to other organs that often accompanies pancreatic trauma is a necessity.
Penetrating pancreatic trauma is almost always associated with injury to the adjacent organs. All patients with gun-shot injuries to the abdomen are indicated for surgical exploration, thus the pancreatic injury is often found at the surgical exploration. After bleeding has been controlled, for treatment of the injured pancreas, simple drainage, or suture of the pancreatic capsule, or pancreatic resection or a patch with an excluded jejunal loop can be used. Partial duodenopancreatectomy is the last option because this procedure is associated with high morbidity and mortality.
本研究旨在介绍我们对枪伤所致穿透性腹部胰腺损伤的诊断和治疗经验。
该组包括在赫拉德茨克拉洛韦大学医院外科和急诊医学科接受治疗的枪伤性腹部胰腺损伤患者。采用美国创伤外科学会（AAST）分类法评估胰腺损伤程度。评估的因素包括手术时机、手术策略、手术时间、失血量、术后并发症，尤其是胰瘘，以及住院时间。根据国际胰腺瘘研究组（ISGPF）对胰瘘进行评估。结果在为期10年的研究期间，治疗了3例枪伤性腹部胰腺损伤患者。
枪伤导致的胰腺创伤是一种罕见损伤，但在捷克共和国也有报道。在任何枪伤性腹部穿透伤中，手术探查总是必要的，胰腺创伤通常在手术中被发现。手术的第一步是检查所有潜在的出血源，因为未控制的出血是术中死亡最常见的原因。对于重伤患者，必须采用损伤控制手术技术。在检查了主要出血源之后，应对所有腹部器官进行全面探查，以确定主胰管是否未受损，如果受损，胰腺的哪个部位受损以及受损程度如何。根据AAST对胰腺损伤进行正确分类对于指明适当的治疗方法是必要的。探查经常伴随胰腺创伤的其他器官损伤也是必要的。
穿透性胰腺创伤几乎总是与相邻器官损伤相关。所有腹部枪伤患者都应进行手术探查，因此胰腺损伤常在手术探查时被发现。在控制出血后，对于受损胰腺，可以采用简单引流、胰腺被膜缝合、胰腺切除或用空肠袢覆盖修补等方法。十二指肠胰腺部分切除术是最后的选择，因为该手术与高发病率和高死亡率相关。
