Mansour M A, Moore J B, Moore E E, Moore F A
Department of Surgery, Denver General Hospital, Colorado 80204.
Am J Surg. 1989 Dec;158(6):531-5. doi: 10.1016/0002-9610(89)90185-2.
We have reviewed our recent 12-year experience in treating 62 patients with combined injuries to the pancreas and duodenum; 60 percent were the consequence of penetrating wounds and 40 percent due to blunt trauma. For analysis, grades I through V were assigned to reflect severity of injury. Grade I (16 percent) and II injuries (23 percent) were treated with simple repair and drainage. Grades III (19 percent) and IV (32 percent) were managed primarily by pyloric exclusion, whereas grade V injuries (10 percent) underwent pancreatoduodenectomy. Pancreatic and duodenal complications developed in 35 percent and 2 percent, respectively. The overall mortality was 19 percent; 83 percent died within the first 24 hours from exsanguination or severe head injury. Although no single procedure uniformly applies to the combined pancreatoduodenal trauma, active sump drainage of the pancreas, pyloric exclusion of the duodenum, and early nutritional support through needle catheter jejunostomy are the mainstay treatment principles.
我们回顾了最近12年治疗62例胰腺和十二指肠联合损伤患者的经验；60%的损伤是由穿透伤所致，40%是由钝性创伤引起。为便于分析，将损伤分为I至V级以反映损伤的严重程度。I级损伤（16%）和II级损伤（23%）采用单纯修复和引流治疗。III级损伤（19%）和IV级损伤（32%）主要采用幽门旷置术治疗，而V级损伤（10%）则行胰十二指肠切除术。胰腺并发症和十二指肠并发症的发生率分别为35%和2%。总体死亡率为19%；83%的患者在最初24小时内死于失血性休克或严重颅脑损伤。虽然没有一种单一的手术方法能统一适用于胰腺十二指肠联合创伤，但胰腺主动持续引流、十二指肠幽门旷置术以及通过针导管空肠造口术进行早期营养支持是主要的治疗原则。
