Akhrass R, Kim K, Brandt C
Department of Surgery, MetroHealth Medical Center, Mt. Sinai Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Am Surg. 1996 Aug;62(8):647-51.
Computed tomography (CT) is currently the modality of choice in evaluating pancreatic injury in patients suffering abdominal trauma who do not require immediate exploration. The purpose of this study was to determine the reliability of initial CT scanning in the detection of pancreatic trauma. A retrospective review was performed of all patients admitted to two Level 1 trauma centers over a 10-year period. Those patients identified with pancreatic injury who underwent initial evaluation with CT scanning were reviewed for clinical course and comparison of CT results with findings at laparotomy. Seventy-two patients of 16,188 admissions (0.4%) were identified with pancreatic injury. Mechanism of injury was blunt in 27 (37%), gunshot wound in 32 (45%), and stab wound in 13 (18%). There were 18 (25%) grade I, 32 (45%) grade II, 16 (22%) grade III, and 5 (7%) grade IV pancreatic injuries. Seventeen of the 72 patients with pancreatic injury underwent initial abdominal CT. The pancreas was normal on CT in 9 and of these, 8 underwent exploration, most commonly secondary to splenic injury. Three were found to have grade I pancreatic injury, two grade II, and three grade III, which required distal pancreatectomy. The pancreas was abnormal on CT in eight patients, and of these three underwent exploration. One patient had an injury upgraded from II on CT to III at exploration and underwent distal pancreatectomy. The mean pancreatic injury by CT was 0.45 versus 2.0 on exploration (P < 0.001). Injury to the pancreas following blunt trauma is rare. Computed tomography will often miss or underestimate pancreatic injuries that require operative treatment, and normal findings on initial scan should not be relied upon to exclude significant pancreatic trauma.
计算机断层扫描（CT）目前是评估腹部创伤患者胰腺损伤的首选方式，这些患者不需要立即进行探查。本研究的目的是确定初始CT扫描在检测胰腺创伤方面的可靠性。对两家一级创伤中心10年内收治的所有患者进行了回顾性研究。对那些经CT扫描进行初始评估且被确诊为胰腺损伤的患者，回顾其临床病程，并将CT结果与剖腹探查结果进行比较。16188例入院患者中有72例（0.4%）被确诊为胰腺损伤。损伤机制为钝性伤27例（37%），枪伤32例（45%），刺伤13例（18%）。胰腺损伤分级为Ⅰ级18例（25%），Ⅱ级32例（45%），Ⅲ级16例（22%），Ⅳ级5例（7%）。72例胰腺损伤患者中有17例接受了初始腹部CT检查。其中9例CT显示胰腺正常，这9例中有8例接受了探查，最常见的原因是继发脾损伤。发现3例为Ⅰ级胰腺损伤，2例为Ⅱ级，3例为Ⅲ级，均需行胰腺远端切除术。8例患者CT显示胰腺异常，其中3例接受了探查。1例患者术中损伤分级从CT显示的Ⅱ级升至Ⅲ级，并接受了胰腺远端切除术。CT显示的平均胰腺损伤程度为0.45，而术中为2.0（P<0.001）。钝性创伤后胰腺损伤罕见。计算机断层扫描常常会漏诊或低估需要手术治疗的胰腺损伤，初始扫描结果正常不能作为排除严重胰腺创伤的依据。
