The Hospital for Sick Children, Division of General and Thoracic Surgery, University of Toronto, Toronto ON, Canada.
J Pediatr Surg. 2013 May;48(5):1060-4. doi: 10.1016/j.jpedsurg.2013.02.027.
Whether children with pancreatic trauma should be managed non-operatively or operatively is controversial. We reviewed outcomes of high-grade pancreatic injuries at two high-volume pediatric surgical centres comparing non-operative and operative management strategies.
All pancreatic traumas presenting from January 1993 to July 2010 were reviewed. Patients with high-grade pancreatic injuries were stratified based on early operative or non-operative therapy. Baseline characteristics and outcomes were compared. Regression analyses were performed to assess complication rates, length of stay, and TPN duration while controlling for injury severity score and associated injuries.
Of 77 patients with pancreatic injuries, 39 were grade 3 or higher. The mean ISS was 19.2 ± 10.8. Nineteen patients (50%) had associated injuries. Fifteen patients (38%) were managed operatively. Baseline characteristics were similar between groups other than ISS (p=0.03). Duration of hospitalization (p=0.01), days of TPN (p=0.003), and overall complications (p=0.007) were higher in non-operative patients. Controlling for both ISS and any associated injury, non-operative management was associated with more complications (OR 8.11; 95% CI 1.60-41.23) and was a significant predictor of prolonged TPN (13 days longer; p=0.024).
Primary non-operative management of high-grade pancreatic injuries is associated with a significant increase in complications and TPN dependency. Early operative intervention should be pursued whenever feasible.
儿童胰腺创伤应采用非手术治疗还是手术治疗存在争议。我们回顾了两个大容量儿科外科中心的高等级胰腺损伤的结果，比较了非手术和手术治疗策略。
回顾了 1993 年 1 月至 2010 年 7 月期间所有的胰腺创伤。根据早期手术或非手术治疗，将高等级胰腺损伤患者分层。比较了基线特征和结果。进行回归分析以评估并发症发生率、住院时间和 TPN 持续时间，同时控制损伤严重程度评分和相关损伤。
77 例胰腺损伤患者中，39 例为 3 级或以上。ISS 平均值为 19.2 ± 10.8。19 例（50%）患者有相关损伤。15 例（38%）患者接受手术治疗。除 ISS 外（p=0.03），两组的基线特征相似。非手术患者的住院时间（p=0.01）、TPN 天数（p=0.003）和总并发症发生率（p=0.007）更高。在控制 ISS 和任何相关损伤后，非手术治疗与更多并发症相关（OR 8.11；95% CI 1.60-41.23），并且是 TPN 依赖性延长的显著预测因素（延长 13 天；p=0.024）。
高等级胰腺损伤的初次非手术治疗与并发症和 TPN 依赖性显著增加相关。只要可行，应尽早进行手术干预。
