创伤性胰腺损伤与治疗结果：一项来自大型三级创伤中心的观察性回顾性研究。
Traumatic pancreatic injuries and treatment outcomes: An observational retrospective study from a high-volume tertiary trauma center.
作者信息
Braden Lindsey A, Minas-Alexander Rebecca, Love Alexis, Hashem Essam, Karuman Philip, Jones Amber L
机构信息
Division of Acute Care and Trauma Surgery, Department of Surgery, Kern Medical Center, 1700 Mount Vernon Ave, Bakersfield, CA, 93306, USA; Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA, 90509, USA.
Division of Acute Care and Trauma Surgery, Department of Surgery, Kern Medical Center, 1700 Mount Vernon Ave, Bakersfield, CA, 93306, USA; Loma Linda University, School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA.
出版信息
Am J Surg. 2025 Apr;242:116142. doi: 10.1016/j.amjsurg.2024.116142. Epub 2024 Dec 10.
INTRODUCTION
This study discusses a tertiary trauma center's experience involving traumatic pancreatic injuries, focusing on identification, management, and complications, aiming to provide a valuable contribution to the literature on pancreatic trauma management.
METHODS
We conducted a five year (2019-2023) retrospective analysis utilizing trauma registry data to identified pancreatic injuries in tier 1 and 2 activations. Pancreatic Organ Injury Scaling (OIS) and overall injury severity (ISS) was assessed using AAST scoring. Data was stratified by mechanism, management, associated injuries, and outcomes.
RESULTS
Thirty-one patients suffering firearm (48.4 %), stabbing (16.1 %), or blunt injuries (35.5 %) were investigated. Firearms correlated with diaphragm (P = 0.047), stomach (P = 0.001) and intrabdominal injury count (P = 0.0042). Robust trends were found between OIS, ISS, complication, mortality and many alike.
CONCLUSION
In penetrating injury, increasing ISS and number of intrabdominal injuries should heighten pancreatic trauma suspicion and lower the threshold for surgical exploration, particularly when involving the diaphragm, stomach, transverse colon or spleen.
引言
本研究探讨了一家三级创伤中心处理创伤性胰腺损伤的经验，重点关注识别、处理及并发症，旨在为胰腺创伤管理的文献提供有价值的贡献。
方法
我们利用创伤登记数据进行了一项为期五年（2019 - 2023年）的回顾性分析，以确定一级和二级激活中的胰腺损伤。使用美国创伤外科学会（AAST）评分评估胰腺器官损伤分级（OIS）和总体损伤严重程度（ISS）。数据按损伤机制、处理方式、相关损伤及结果进行分层。
结果
对31例遭受火器伤（48.4%）、刺伤（16.1%）或钝性伤（35.5%）的患者进行了调查。火器伤与膈肌损伤（P = 0.047）、胃损伤（P = 0.001）及腹腔内损伤计数相关（P = 0.0042）。在OIS、ISS、并发症、死亡率及许多其他方面发现了显著趋势。
结论
在穿透伤中，ISS增加及腹腔内损伤数量增多应提高对胰腺创伤的怀疑，并降低手术探查阈值，特别是当涉及膈肌、胃、横结肠或脾脏时。
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