Uchida Kenichiro, Hagawa Naohiro, Miyashita Masahiro, Maeda Toshiki, Kaga Shinichiro, Noda Tomohiro, Nishimura Tetsuro, Yamamoto Hiromasa, Mizobata Yasumitsu
Department of Traumatology and Critical Care Medicine Osaka City University Graduate School of Medicine Osaka Japan.
Acute Med Surg. 2020 Apr 13;7(1):e502. doi: 10.1002/ams2.502. eCollection 2020 Jan-Dec.
Management of traumatic pancreatic injury is challenging, and mortality and morbidity remain high. Because pancreatic injury is uncommon and strong recommendations for pancreatic injury management are lacking, management is primarily based on institutional practices. We propose our strategy of pancreatic injury management.
We retrospectively reviewed patients with pancreatic injury and evaluated our strategy and outcomes.
From January 2013 to December 2019, 18 patients were included with traumatic pancreatic injury. The median Injury Severity Score was 22 (25-75% interquartile range, 17-34) and probability of survival was 0.87 (25-75% interquartile range, 0.78-0.93). Patients were grouped according to the American Association for the Surgery of Trauma injury grades: grade I, = 3 (16.7%); II, = 6 (33.3%); III, = 7 (38.9%); and IV, = 2 (11.1%). All patients underwent endoscopic pancreatic ductal evaluation within 1-2 days after admission. Abbreviated surgery because of hemodynamic instability and subsequent open abdominal management were undertaken in one patient with pancreas head injury and two patients with pancreas body/tail injury. Management was by laparotomy for closed suction drain insertion with main ductal endoscopic drainage in six patients, endoscopic ductal drainage only in six patients, and distal pancreatectomy with closed suction drainage and endoscopic drainage in five patients. One patient with grade I injury underwent observation only. Median length of closed suction drainage was 12 days and that of hospital stay was 36 days. The observed mortality during the study period was 0%. Late formation of pseudo-pancreatic cyst was observed in two patients (11.1%).
Our uniform, simplified strategy offers good outcomes for any pancreatic injury site and any concomitant injuries, even in hemodynamically unstable patients.
创伤性胰腺损伤的管理具有挑战性，死亡率和发病率仍然很高。由于胰腺损伤并不常见，且缺乏针对胰腺损伤管理的强有力建议，管理主要基于机构实践。我们提出我们的胰腺损伤管理策略。
我们回顾性分析了胰腺损伤患者，并评估了我们的策略和结果。
2013年1月至2019年12月，纳入18例创伤性胰腺损伤患者。损伤严重程度评分中位数为22（四分位数间距25 - 75%，17 - 34），生存概率为0.87（四分位数间距25 - 75%，0.78 - 0.93）。患者根据美国创伤外科学会损伤分级进行分组：I级，3例（16.7%）；II级，6例（33.3%）；III级，7例（38.9%）；IV级，2例（11.1%）。所有患者在入院后1 - 2天内接受了内镜下胰管评估。1例胰头损伤患者和2例胰体/胰尾损伤患者因血流动力学不稳定进行了简化手术，随后进行了开放腹部处理。6例患者通过剖腹术置入闭式吸引引流管并进行主胰管内镜引流，6例患者仅进行内镜下胰管引流，5例患者进行胰体尾切除术并进行闭式吸引引流和内镜引流。1例I级损伤患者仅接受观察。闭式吸引引流的中位时间为12天，住院中位时间为36天。研究期间观察到的死亡率为0%。2例患者（11.1%）出现了胰腺假性囊肿的晚期形成。
我们统一、简化的策略对于任何胰腺损伤部位和任何合并伤都能提供良好的结果，即使是血流动力学不稳定的患者。
