Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States.
Am J Surg. 2018 Aug;216(2):299-303. doi: 10.1016/j.amjsurg.2018.06.002. Epub 2018 Jun 12.
Pancreatic trauma management hinges upon the presence or absence of pancreatic duct injury, but the optimal method of assessment is unclear. This study endeavored to evaluate the methods of pancreatic duct assessment in modern practice.
Patients presenting to LAC + USC Medical Center (01/2008-06/2015) with a pancreatic injury were identified (ICD-9 codes). Demographics, clinical data, technique of duct evaluation, and outcomes were analyzed.
71 patients with pancreatic injury were identified. 21 patients (30%) underwent CT scan (sensitivity 76%). Sixteen (76%) then underwent laparotomy while 5 (24%) were managed successfully nonoperatively. Most (n = 50, 70%) underwent immediate laparotomy. Overall, 66 patients (93%) were managed operatively. The majority were assessed intraoperatively for ductal injury with visual inspection alone (n = 62, 94%). Four (6%) underwent intraoperative pancreatography via duodenotomy/cholecystotomy, which were all inconclusive.
In the evaluation of pancreatic duct injury, intraoperative pancreatography is frequently inconclusive and should have a limited role. Clinical suspicion for ductal injury based on intraoperative visual inspection alone should guide the management of pancreatic injuries.
胰腺创伤的处理取决于是否存在胰管损伤，但评估的最佳方法尚不清楚。本研究旨在评估现代实践中胰管评估的方法。
确定 LAC + USC 医疗中心（2008 年 1 月至 2015 年 6 月）就诊的胰腺损伤患者（ICD-9 编码）。分析了患者的人口统计学、临床数据、胰管评估技术和结果。
确定了 71 例胰腺损伤患者。21 例（30%）行 CT 扫描（敏感性 76%）。16 例（76%）随后行剖腹手术，5 例（24%）成功非手术治疗。大多数（n=50，70%）立即行剖腹手术。总体而言，66 例患者（93%）接受了手术治疗。大多数患者在术中通过单纯肉眼观察评估胰管损伤（n=62，94%）。4 例（6%）经十二指肠切开术/胆囊切开术行术中胰管造影，均无定论。
在评估胰管损伤时，术中胰管造影常无定论，作用有限。基于术中肉眼观察到的胰管损伤的临床怀疑应指导胰腺损伤的处理。
