From the Department of Surgery, University of Calgary, Calgary, Alta. (Streith, Silverberg, Kirkpatrick, Bathe, Ball); and the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed).
Can J Surg. 2020 Sep-Oct;63(5):E431-E434. doi: 10.1503/cjs.013919.
Hepato-pancreato-biliary (HPB) injuries can be extremely challenging to manage. This scoping review (8438 citations) offers a number of recommendations. If diagnosis and therapy are rapid, patients with major hepatic injuries who present in physiologic extremis have high survival rates despite prolonged hospital stays. Nonoperative management of major liver injuries, as diagnosed using computed tomography, is typically successful. Adjuncts (e.g., angioembolization, laparoscopic washouts, biliary stents) are essential in managing high-grade injuries. Injury to the extrahepatic biliary tree is rare. Cholecystectomy is indicated for all gallbladder trauma. Full-thickness common bile duct injuries require a hepaticojejunostomy, although damage control remains closed suction drainage. Injuries to the pancreatic head often involve concurrent trauma to regional vasculature. Damage control necessitates drainage after stopping hemorrhage. Injury to the left pancreas commonly requires a distal pancreatectomy. Outcomes for high-grade pancreatic and liver injuries are improved by involving an HPB team. Complications are multidisciplinary and should be managed without delay.
肝胆胰（HPB）损伤的处理极具挑战性。这篇范围界定综述（8438 条引文）提出了一些建议。如果诊断和治疗迅速，即使住院时间延长，在生理极限下表现出严重肝损伤的患者仍有很高的存活率。使用计算机断层扫描诊断的严重肝损伤通常可通过非手术治疗成功。辅助治疗（例如血管栓塞、腹腔镜冲洗、胆道支架）对于治疗高级别损伤至关重要。肝外胆管树损伤很少见。所有胆囊创伤都需要行胆囊切除术。全层胆总管损伤需要行胆肠吻合术，尽管损伤控制仍采用闭式引流。胰头部损伤常伴有局部血管的并发创伤。控制出血后需要引流。左胰腺损伤常需要行胰体尾切除术。涉及肝胆胰团队可改善高级别胰腺和肝脏损伤的预后。并发症是多学科的，应立即处理。
