Graham J M, Mattox K L, Vaughan G D, Jordan G L
J Trauma. 1979 May;19(5):340-6. doi: 10.1097/00005373-197905000-00007.
Operative management of combined pancreatic and duodenal injuries has been a controversial subject in recent years. Methods advocated include resection, duodenal diversion, and simple repair and drainage. Excellent results have been reported with each of these, but most reported series are small, preventing definitive conclusions concerning the value of any treatment modality. During an 8-year period ending December 1976, 308 pancreatic injuries and 175 duodenal injuries were treated. Sixty-eight of the patients had combined pancreatic and duodenal injuries and constitute the basis for this report. Fifty-five patients sustained penetrating injuries and 13 had blunt injuries. Eighteen underwent repair and drainage. The remaining 50 required more extensive procedures which included duodenal diversion and pyloric exclusion in 32, pancreatoduodenectomy in six, and a variety of procedures in the remainder. The operative mortality rate was 26.4%, including five patients who died intraoperatively. In the entire series only one death was directly attributable to the pancreatoduodenal injury. We conclude that no single procedure is uniformly applicable to these injuries. Surgeons treating trauma of this severity should be familiar with a variety of techniques for repair, and treatment should be individualized. Preservation of tissue should be accomplished when possible.
近年来，胰腺和十二指肠联合损伤的手术治疗一直是一个有争议的话题。所提倡的方法包括切除术、十二指肠改道术以及单纯修复和引流术。采用这些方法均有良好效果的报道，但大多数报道的病例系列规模较小，因此无法就任何一种治疗方式的价值得出明确结论。在截至1976年12月的8年期间，共治疗了308例胰腺损伤和175例十二指肠损伤。其中68例患者同时存在胰腺和十二指肠损伤，构成了本报告的基础。55例为穿透伤，13例为钝性伤。18例接受了修复和引流术。其余50例需要更广泛的手术，其中32例行十二指肠改道术和幽门旷置术，6例行胰十二指肠切除术，其余行各种不同的手术。手术死亡率为26.4%，其中5例患者术中死亡。在整个系列中，只有1例死亡直接归因于胰十二指肠损伤。我们得出结论，没有一种单一的手术方法能普遍适用于这些损伤。治疗这种严重创伤的外科医生应熟悉多种修复技术，治疗应个体化。应尽可能保留组织。
