Degiannis E, Levy R D, Velmahos G C, Potokar T, Florizoone M G, Saadia R
Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa.
World J Surg. 1996 Jan;20(1):68-71; discussion 72. doi: 10.1007/s002689900012.
This study is comprised of 48 patients with gunshot injuries of the head of the pancreas, many of which were high velocity injuries. The purpose of this study was to evaluate our management policy for these injuries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postoperative mortality, respectively, directly related to the pancreatic injury. For patients in whom the duodenum was involved, pyloric exclusion was applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by débridement and suture repair, with or without drainage. Severe (grade IV) injuries warrant a pancreaticoduodenectomy. Most grade III injuries can be treated by débridement and drainage unless an associated severe duodenal injury is present, in which case resection may be indicated.
本研究包括48例胰腺头部枪伤患者，其中许多为高速伤。本研究的目的是基于我们近期丰富的经验评估我们对这些损伤的处理策略。II级和III级损伤的患者接受了保守手术，术后死亡率分别为0%和21%，均直接与胰腺损伤相关。对于十二指肠受累的患者，根据十二指肠损伤的分级采用幽门旷置术。我们得出结论，胰腺头部中度枪伤（II级）可通过清创缝合修复安全治疗，可留置或不留置引流。严重（IV级）损伤需要行胰十二指肠切除术。大多数III级损伤可通过清创引流治疗，除非伴有严重十二指肠损伤，在这种情况下可能需要行切除术。
