Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway.
Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Stanford University Department of Surgery, Section of Trauma and Critical Care, Stanford, CA, USA.
HPB (Oxford). 2018 Dec;20(12):1099-1108. doi: 10.1016/j.hpb.2018.05.009. Epub 2018 Jul 11.
Pancreatic injury is rare and optimal diagnosis and management is still debated. The aim of this study was to review the existing data and consensus on management of pancreatic trauma.
Systematic literature review until May 2018.
Pancreas injury is reported in 0.2-0.3% of all trauma patients. Severity is scored by the organ injury scale (OIS), with new scores including physiology needing validation. Diagnosis is difficult, clinical signs subtle, and imaging by ultrasound (US) and computed tomography (CT) non-specific with <60% sensitivity for pancreatic duct injury. MRCP and ERCP have superior sensitivity (90-100%) for detecting ductal disruption. Early ERCP with stent is a feasible approach for initial management of all branch-duct and most main-duct injuries. Distal pancreatectomy (±splenectomy) may be required for a transected gland distal to the major vessels. Early peripancreatic fluid collections are common in ductal injuries and one-fifth may develop pseudocysts, of which two-thirds can be managed conservatively. Non-operative management has a high success rate (50-75%), even in high-grade injuries, but associated with morbidity. Mortality is related to associated injuries.
Pancreatic injuries are rare and can often be managed non-operatively, supported by percutaneous drainage and ductal stenting. Distal pancreatectomy is the most common operative procedure.
胰腺损伤较为罕见，其最佳诊断和治疗仍存在争议。本研究旨在回顾胰腺创伤处理方面现有的数据和共识。
系统检索截至 2018 年 5 月的文献。
胰腺损伤占所有创伤患者的 0.2-0.3%。严重程度由器官损伤评分（OIS）进行评分，新的评分包括需要验证的生理学评分。诊断较为困难，临床症状不明显，超声（US）和计算机断层扫描（CT）检查不具有特异性，对胰管损伤的敏感性<60%。磁共振胰胆管造影（MRCP）和内镜逆行胰胆管造影（ERCP）对检测胆管破裂具有更高的敏感性（90-100%）。对于所有分支胆管和大多数主胆管损伤，早期 ERCP 加支架置入是初始治疗的可行方法。对于大血管远端的离断性胰腺，可能需要进行远端胰腺切除术（±脾切除术）。早期胰周积液在胰管损伤中很常见，五分之一可能发展为假性囊肿，其中三分之二可以保守治疗。非手术治疗成功率较高（50-75%），即使是在高分级损伤中，但其相关并发症发病率较高。死亡率与合并伤相关。
胰腺损伤较为罕见，大多数情况下可通过经皮引流和胰管支架置入进行非手术治疗，其中远端胰腺切除术是最常见的手术方法。
