Nieß H, Werner J
Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, LMU Klinikum, LMU München, München, Deutschland.
Chirurgie (Heidelb). 2023 Aug;94(8):675-681. doi: 10.1007/s00104-023-01898-7. Epub 2023 Jun 27.
Pancreatic injuries resulting from blunt abdominal trauma are uncommon but carry a high risk of morbidity and mortality for patients. Prompt diagnosis and management are critical to optimize patient outcomes. This review article provides an overview of the different types of pancreatic injuries and the various management strategies available, based on the severity of the injury. In unstable patients with a positive focused assessment with sonography for trauma (FAST), immediate trauma laparotomy is required. Stable patients should be assessed with contrast-enhanced computed tomography (CT) imaging. Low-grade injuries can be managed with irrigation and drainage. In cases of left-sided ductal injury below the level of the portal vein, left-sided pancreatic resection is often necessary. Higher grade injuries to the pancreatic head need to be evaluated in the context of other accompanying injuries, where damage control may be required. Pancreaticoduodenectomy is a rare intervention and is usually only required in the later course in these cases.
钝性腹部创伤导致的胰腺损伤并不常见，但对患者来说具有较高的发病和死亡风险。及时诊断和处理对于优化患者预后至关重要。这篇综述文章基于损伤的严重程度，概述了不同类型的胰腺损伤以及可用的各种处理策略。对于创伤重点超声评估（FAST）呈阳性的不稳定患者，需要立即进行创伤剖腹探查术。稳定的患者应进行增强计算机断层扫描（CT）成像评估。轻度损伤可通过冲洗和引流进行处理。对于门静脉水平以下的左侧导管损伤，通常需要进行左侧胰腺切除术。胰腺头部的较高级别损伤需要结合其他伴随损伤进行评估，可能需要采取损伤控制措施。胰十二指肠切除术是一种罕见的干预措施，通常仅在这些病例的后期才需要进行。
