Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2021 Mar;23(3):180-185.
Pancreatic trauma is uncommon in pediatric patients and presents diagnostic and therapeutic challenges. While non-operative management (NOM) of minor pancreatic injuries is well accepted, the management of major pancreatic injuries remains controversial.
To evaluate management strategies for major blunt pancreatic injury in children.
Data were retrospectively collected for all children treated for grade III or higher pancreatic injury due to blunt abdominal trauma from 1992 to 2015 at two medical centers. Data included demographics, mechanism of injury, laboratory and imaging studies, management strategy, clinical course, operative findings, and outcome.
The cohort included seven boys and four girls aged 4-15 years old (median 9). Six patients had associated abdominal (mainly liver, n=3) injuries. The main mechanism of injury was bicycle (handlebar) trauma (n=6). Five patients had grade III injury and six had grade IV. The highest mean amylase level was recorded at 48 hours after injury (1418 U/L). Management strategies included conservative (n=5) and operative treatment (n=6): distal (n=3) and central (n=1) pancreatectomy, drainage only (n=2) based on the computed tomography findings and patient hemodynamic stability. Pseudocyst developed in all NOM patients (n=5) and two OM cases, and one patient developed a pancreatic fistula. There were no differences in average length of hospital stay.
NOM of high-grade blunt pancreatic injury in children may pose a higher risk of pseudocyst formation than OM, with a similar hospitalization time. However, pseudocyst is a relatively benign complication with a high rate of spontaneous resolution with no need for surgical intervention.
胰腺创伤在儿科患者中较为少见，其诊断和治疗具有挑战性。虽然人们普遍接受非手术治疗（NOM）轻微胰腺损伤，但严重胰腺损伤的治疗仍存在争议。
评估儿童严重钝性胰腺损伤的治疗策略。
回顾性收集了 1992 年至 2015 年在两个医疗中心因钝性腹部创伤导致的 3 级或 3 级以上胰腺损伤的所有儿童的治疗数据。数据包括人口统计学资料、损伤机制、实验室和影像学研究、治疗策略、临床过程、手术结果和结局。
该队列包括 7 名男孩和 4 名女孩，年龄为 4-15 岁（中位数 9 岁）。6 例患儿合并腹部（主要为肝脏）损伤。主要损伤机制为自行车（把手）创伤（n=6）。5 例患者为 3 级损伤，6 例为 4 级损伤。受伤后 48 小时记录到的最高平均淀粉酶水平为 1418 U/L。治疗策略包括保守治疗（n=5）和手术治疗（n=6）：根据 CT 发现和患者血流动力学稳定性，远端（n=3）和中央（n=1）胰腺切除术，仅引流（n=2）。所有接受 NOM 治疗的患者（n=5）和 2 例接受 OM 治疗的患者（n=2）均发生假性囊肿，1 例患者发生胰瘘。平均住院时间无差异。
与 OM 相比，NOM 治疗儿童严重钝性胰腺损伤可能会增加假性囊肿形成的风险，但住院时间相似。然而，假性囊肿是一种相对良性的并发症，自发消退的比例较高，无需手术干预。
