Jones R C
Am J Surg. 1985 Dec;150(6):698-704. doi: 10.1016/0002-9610(85)90412-x.
The majority of patients who sustain penetrating blunt trauma to the pancreas can be managed with sump drainage, including those with gunshot wounds to the head of the pancreas. Pancreatico-duodenectomy may be indicated in 2 to 3 percent of cases of pancreatic injury. Patients who require resection of 80 percent or more of the pancreas and do not have splenic injury should be considered for a Roux-Y anastomosis to the distal pancreas after ductal injury has been proved. Severe injuries to the body of the pancreas are best managed by distal pancreatectomy. The mortality rate due to pancreatic injury has been less than 3 percent and rarely is the cause of death. To support this conclusion, few normotensive patients die, and no patient with an isolated pancreatic injury in our series died. The severity of injury often dictates the appropriate treatment. A conservative approach is indicated for most pancreatic injuries, resulting in shorter operating time and less blood loss in the unstable patient with multiple injuries. Most important is identification of ductal injury at the initial operation and institution of surgical drainage.
大多数胰腺遭受穿透性钝性创伤的患者可通过引流管引流进行治疗，包括胰腺头部有枪伤的患者。在2%至3%的胰腺损伤病例中可能需要进行胰十二指肠切除术。对于胰腺切除80%或更多且无脾脏损伤的患者，在证实有导管损伤后，应考虑对远端胰腺进行Roux-Y吻合术。胰腺体部的严重损伤最好通过胰腺远端切除术进行治疗。胰腺损伤导致的死亡率低于3%，很少是死亡原因。为支持这一结论，很少有血压正常的患者死亡，在我们的系列病例中，没有孤立性胰腺损伤的患者死亡。损伤的严重程度通常决定了适当的治疗方法。大多数胰腺损伤适合采用保守方法，这对于有多处损伤的不稳定患者来说，可缩短手术时间并减少失血量。最重要的是在初次手术时识别导管损伤并进行手术引流。
