一级创伤中心77例胰腺损伤分析：保守治疗与手术治疗的结果
An analysis of 77 cases of pancreatic injuries at a level one trauma center: Outcomes of conservative and surgical treatments.
作者信息
Khalayleh Harbi, Imam Ashraf, Cohen-Arazi Oded, Yoav Pikkel, Helou Brigitte, Miklosh Bala, Pikarsky Alon J, Khalaileh Abed
机构信息
Department of Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
出版信息
Ann Hepatobiliary Pancreat Surg. 2022 May 31;26(2):190-198. doi: 10.14701/ahbps.21-144.
BACKGROUNDS/AIMS: Traumatic pancreatic injury (TPI) is rare as an isolated injury. There is a trend to perform conservative treatment even in patients with complete duct dissection and successful treatment. This study reviewed our 20 years of experience in the management of TPI and assessed patient outcomes according to age group and treatment strategy.
METHODS
A retrospective analysis of patients diagnosed and treated with TPI at a level-I trauma center from 2000-2019. Patients were divided into two groups: adults and pediatrics. Conservative treatment cases were subjected to subgroup analysis. Level of evidence: IV.
RESULTS
Of a total of 77 patients, the mean age was 24.89 ± 15.88 years. Fifty-six (72.7%) patients had blunt trauma with motor vehicle accident. Blunt trauma was the predominant mechanism in 42 (54.5%) patients. Overall, 38 (49.4%) cases had grade I or II injury, 24 (31.2%) had grade III injury, and 15 (19.5%) had grade IV injury. A total of 30 cases had non-operative management (NOM). Successful NOM was observed in 16 (20.8%) cases, including eight (32.0%) pediatric cases and eight (15.4%) adult cases. Higher American association for the surgery of trauma (AAST) grade of injury was associated with NOM failure (16.7% for grade I/II, 100% for grade III, and 66.7% for grade IV injury; = 0.001). An independent factor for NOM failure was female sex (69.2% in females vs. 29.4% in males; = 0.03).
CONCLUSIONS
High AAST grade TPI is associated with a high rate of NOM failure in both pediatric and adults.
背景/目的：创伤性胰腺损伤（TPI）作为孤立损伤较为罕见。即使在胰管完全离断且治疗成功的患者中，也存在采取保守治疗的趋势。本研究回顾了我们20年来TPI的治疗经验，并根据年龄组和治疗策略评估了患者的预后。
方法
对2000年至2019年在一级创伤中心诊断并治疗的TPI患者进行回顾性分析。患者分为两组：成人组和儿童组。对保守治疗病例进行亚组分析。证据级别：IV级。
结果
总共77例患者，平均年龄为24.89±15.88岁。56例（72.7%）患者因机动车事故导致钝性创伤。钝性创伤是42例（54.5%）患者的主要致伤机制。总体而言，38例（49.4%）为I级或II级损伤；24例（31.2%）为III级损伤；15例（19.5%）为IV级损伤。共有30例患者接受了非手术治疗（NOM）。16例（20.8%）患者非手术治疗成功，其中包括8例（32.0%）儿童病例和8例（15.4%）成人病例。美国创伤外科协会（AAST）损伤分级越高，非手术治疗失败的可能性越大（I/II级为16.7%，III级为100%，IV级为66.7%；P=0.001）。非手术治疗失败的独立因素为女性（女性为69.2%，男性为29.4%；P=0.03）。
结论
高AAST分级的TPI在儿童和成人中均与非手术治疗的高失败率相关。
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