Katz Micah G, Fenton Stephen J, Russell Kathryn W, Scaife Eric R, Short Scott S
Division of Pediatric Surgery, Department of Surgery, Primary Children's Hospital, University of Utah School of Medicine, 100 N. Mario Cappechi Drive, Suite 3800, Salt Lake City, UT, 84113, USA.
Pediatr Surg Int. 2018 Jun;34(6):641-645. doi: 10.1007/s00383-018-4249-x. Epub 2018 Apr 5.
To examine surgical outcomes of children with pancreaticoduodenal injuries at a Quaternary Level I pediatric trauma center.
We queried a prospectively maintained trauma database of a level one pediatric trauma center for all cases of pancreatic and/or duodenal injury from 2002 to 2017. Analysis was conducted using JMP 13.1.0.
170 children presented with pancreatic and/or duodenal injury. 13 (7.7%) suffered a combined injury and this group forms the basis for this report with mean ISS of 22.8 (± 15.1), RTS2 of 6.4(± 2.1), and median age of 6.6 (1.3-13.5) years. Child abuse (31%) and bicycle injuries (23%) were the most common mechanisms. 8/13 (61.5%) required operative intervention. Higher AAST pancreatic and duodenal injury grade (2.9 vs. 1.2, p = 0.05 and 3.6 vs. 1.4, p = < 0.01), lower RTS2 (7.84 vs. 5.49, p < 0.01), and lower GCS (9.6 vs. 15, p = 0.03) predicted operative intervention. 6/8 (75%) undergoing surgery survived to discharge with only (2/6) survivors suffering postoperative complications. Both mortalities were secondary to severe traumatic brain injury.
Surgical management of complex pancreaticoduodenal injury is an uncommon traumatic event that is associated with high injury severity, but survival occurs in most scenarios.
在一家四级一级儿科创伤中心研究胰十二指肠损伤患儿的手术结果。
我们查询了一家一级儿科创伤中心前瞻性维护的创伤数据库，以获取2002年至2017年所有胰腺和/或十二指肠损伤病例。使用JMP 13.1.0进行分析。
170名儿童出现胰腺和/或十二指肠损伤。13名（7.7%）遭受复合伤，该组构成本报告的基础，平均损伤严重度评分（ISS）为22.8（±15.1），修订创伤评分2（RTS2）为6.4（±2.1），中位年龄为6.6（1.3 - 13.5）岁。虐待儿童（31%）和自行车伤（23%）是最常见的致伤机制。8/13（61.5%）需要手术干预。较高的美国创伤外科学会（AAST）胰腺和十二指肠损伤分级（2.9对1.2，p = 0.05；3.6对1.4，p < 0.01）、较低的RTS2（7.84对5.49，p < 0.01）和较低的格拉斯哥昏迷量表（GCS）评分（9.6对15，p = 0.03）预示需要手术干预。8名接受手术的患儿中有6名（75%）存活至出院，只有2/6的幸存者出现术后并发症。两名死亡病例均继发于严重创伤性脑损伤。
复杂胰十二指肠损伤的手术治疗是一种罕见的创伤事件，与高损伤严重度相关，但在大多数情况下可存活。
