Takishima T, Sugimoto K, Sakaguchi T, Asari Y, Kikuno T, Kakita A, Owada T
Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine, Sagamihara, Japan.
Nihon Geka Gakkai Zasshi. 1995 Aug;96(8):569-76.
To determine the therapeutic modalities for pancreatic injury (PI), it is important for the pancreatic ductal injury (DI) to be present or not. We performed ERPs in 36 patients who had positive findings in physical examinations, serum amylase levels and CT within about 13 hours after injury to diagnose the DIs early after injury and to avoid negative laparotomy. In 33 successful ERP patients (intraoperatively in 3), 22 had PIs (14 DIs) and 11 had non-PIs. Of 14 patients with DIs, 12 with main DIs and one with branch injury were treated surgically. Another patient with branch injury, who was treated conservatively, died of the complications of PI. Nineteen patients without DIs, including 8 PIs, were treated conservatively or operated for the associated abdominal injuries, who had no complications on PIs in the hospital days. Three unsuccessful ERP patients, having PIs, were also operated upon. Among 15 patients, including these 3 patients and 12 treated surgically during the era before introducing ERPs, 2 (13.3%) negative laparotomies were noted. Among 16 patients, who underwent both of ERP and operation, no negative laparotomies were noted. No complications of ERPs occurred. In conclusion, ERP is a reliable modality to detect DIs and to determine the therapeutic modalities for PIs.
为确定胰腺损伤（PI）的治疗方式，胰腺导管损伤（DI）是否存在至关重要。我们对36例在受伤后约13小时内体格检查、血清淀粉酶水平及CT检查有阳性发现的患者进行了内镜逆行胰胆管造影（ERP），以在损伤后早期诊断DI并避免阴性剖腹探查。在33例ERP成功的患者（3例术中进行）中，22例有PI（14例有DI），11例无PI。14例有DI的患者中，12例主胰管损伤和1例分支损伤患者接受了手术治疗。另1例分支损伤患者保守治疗，死于PI并发症。19例无DI的患者，包括8例有PI的患者，接受了保守治疗或因相关腹部损伤进行了手术，住院期间PI无并发症。3例ERP不成功且有PI的患者也接受了手术。在包括这3例患者以及在引入ERP之前的时期内接受手术治疗的12例患者的15例患者中，发现2例（13.3%）阴性剖腹探查。在16例既接受了ERP又接受了手术的患者中，未发现阴性剖腹探查。未发生ERP并发症。总之，ERP是检测DI及确定PI治疗方式的可靠方法。
