Whittwell A E, Gomez G A, Byers P, Kreis D J, Manten H, Casillas V J
Department of Radiology, University of Miami/Jackson Memorial Medical Center, Fla.
South Med J. 1989 May;82(5):586-91.
Major ductal injury is a determining factor in the outcome after pancreatic trauma. The purpose of this study was to determine the value of early endoscopic retrograde pancreatography (ERP) in patients with blunt pancreatic trauma. We attempted ERP in nine patients. Indications were abnormal pancreatic findings on CT scanning in five patients, a suboptimal view on CT scanning in three patients, and a high index of suspicion in one patient. ERP was successful in eight patients. Two had major ductal injury treated operatively and were discharged without complications. In six, ERP showed a normal pancreatic duct. These patients were treated conservatively; five were eventually discharged, and one died of necrotizing pneumonia. Our results suggest that ERP is safe and accurate in the diagnosis of blunt pancreatic ductal injuries. If the pancreatic ductal system is intact, conservative management is appropriate, but if ERP shows major ductal injury, surgical intervention is indicated.
主胰管损伤是胰腺创伤后预后的决定性因素。本研究的目的是确定早期内镜逆行胰胆管造影（ERP）在钝性胰腺创伤患者中的价值。我们对9例患者进行了ERP检查。指征包括5例CT扫描显示胰腺异常、3例CT扫描视野欠佳以及1例高度怀疑。8例患者ERP检查成功。2例主胰管损伤患者接受了手术治疗，出院时无并发症。6例患者ERP显示胰管正常。这些患者接受了保守治疗；5例最终出院，1例死于坏死性肺炎。我们的结果表明，ERP在钝性胰管损伤的诊断中安全且准确。如果胰管系统完整，保守治疗是合适的，但如果ERP显示主胰管损伤，则需进行手术干预。
