Hagan W V, Urdaneta L F, Stephenson S E
South Med J. 1978 Aug;71(8):892-4. doi: 10.1097/00007611-197808000-00006.
During the ten-year period from 1967 to 1977, 50 cases of pancreatic trauma were reviewed. There were 40 gunshot wounds, six stab wounds, and four cases of blunt abdominal trauma. Ten of the patients died, a mortality of 20%. The overall complication rate was 57%, but only 27% had complications attributable to the pancreatic injury. As has been reported by most authors, there is a high incidence of associated injuries. In our series only one patient had isolated pancreatic injury, while 30% had a major vascular injury, and the mortality for this group was 50%. Several methods of treatment were used, but the majority (36 patients) had drainage alone. The others had either resection (five) or Roux-en-Y pancreaticojejunostomy (five). Of particular interest were results of treatment of severe injuries to the head of the pancreas. Early in the series two patients were treated by pancreaticoduodenectomy and both died within 24 hours. During the last year we have treated five similar injuries using a Puestow type of Roux-en-Y pancreaticojejunostomy, with one death and no pancreatic complications. At present we advocate sump tube drainage for most injuries but rely on a Roux-en-Y pancreaticojejunostomy for severe injury to the head of the pancreas rather than resection.
在1967年至1977年的十年间，对50例胰腺创伤病例进行了回顾性研究。其中有40例枪伤、6例刺伤和4例腹部钝性创伤。10例患者死亡，死亡率为20%。总体并发症发生率为57%，但仅有27%的并发症归因于胰腺损伤。正如大多数作者所报道的，合并伤的发生率很高。在我们的系列病例中，只有1例患者为单纯胰腺损伤，而30%的患者伴有主要血管损伤，该组患者的死亡率为50%。采用了几种治疗方法，但大多数患者（36例）仅进行了引流。其他患者分别接受了切除术（5例）或Roux-en-Y胰空肠吻合术（5例）。胰腺头部严重损伤的治疗结果尤其令人关注。在该系列研究早期，2例患者接受了胰十二指肠切除术，均在24小时内死亡。在过去一年中，我们采用Puestow式Roux-en-Y胰空肠吻合术治疗了5例类似损伤，1例死亡，无胰腺并发症。目前，对于大多数损伤我们主张采用引流管引流，但对于胰腺头部的严重损伤，我们依靠Roux-en-Y胰空肠吻合术而非切除术。
