Degiannis E, Levy R D, Potokar T, Lennox H, Rowse A, Saadia R
Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, South Africa.
Br J Surg. 1995 Sep;82(9):1240-2. doi: 10.1002/bjs.1800820927.
This study comprised 57 patients with gunshot injury of the distal pancreas. There were 16 grade II, 29 grade III and 12 grade IV pancreatic injuries. The intraoperative mortality rate was 12 per cent. Patients with the most severe grade II injuries and all those with grade III and IV injuries had distal pancreatectomy and splenectomy, with a 14 per cent fistula formation rate and 2.3 per cent postoperative mortality rate directly related to the pancreatic injury. The remaining patients with grade II injuries were managed by debridement and drainage; there were no fistulas or deaths. The method of closure of the pancreatic resection margin is unrelated to fistula formation, and identification of the duct for ligation is unnecessary. Liberal use of distal pancreatectomy with splenectomy for gunshot injuries of the distal pancreas is suggested.
本研究纳入了57例胰腺远端枪伤患者。其中有16例二级、29例三级和12例四级胰腺损伤。术中死亡率为12%。二级损伤中最严重的患者以及所有三级和四级损伤患者均接受了胰腺远端切除术和脾切除术，胰瘘形成率为14%，与胰腺损伤直接相关的术后死亡率为2.3%。其余二级损伤患者采用清创引流治疗；未出现胰瘘或死亡情况。胰腺切除边缘的闭合方法与胰瘘形成无关，无需识别导管进行结扎。建议对胰腺远端枪伤广泛采用胰腺远端切除术加脾切除术。
