Keller M S, Stafford P W, Vane D W
Department of Surgery, Children's Hospital of Philadelphia, Pennsylvania, USA.
J Trauma. 1997 Jun;42(6):1097-100. doi: 10.1097/00005373-199706000-00019.
Many adults and most children with a solid-organ abdominal injury can be managed nonoperatively. To date, however, little is known about the outcome of nonoperative management of pancreatic injury. To analyze current treatment patterns of pancreatic injury in children, all children (age < 19 years) identified in the National Pediatric Trauma Registry (49,540 patients) and admitted to two level I pediatric trauma centers with a diagnosis of injury to the pancreas (International Classification of Disease-9 codes 863.81-863.84 and 863.91-863.94) were reviewed. Over a 7-year period, 154 children were identified with pancreatic injury. Thirty-one (20%) sustained severe injuries (grades III, IV, or V) and 123 (80%) sustained lower-grade injuries (grades I and II). Sixteen (52%) of the children sustaining grades III, IV, or V injury required pancreatic procedures (9 distal resections, 3 simple repairs, 2 enteric anastomoses, 2 others). Only 26 (21%) of the grades I and II injuries required surgical intervention specific to the pancreas (11 resections, 9 catheter drainage of pseudocysts, 2 enteric anastomoses, 4 others). Ninety-seven (79%) grades I and II injuries were successfully managed conservatively. Overall, 15 (10%) children required drainage procedures for pseudocyst. The frequency of operative intervention decreased during the last 4 years of the study (18 vs. 26%, p > 0.05), coinciding with a decrease in the frequency of drainage procedures for pseudocysts. The need for surgical intervention was not influenced by age, Injury Severity Score, or Pediatric Trauma Score (p > 0.05). Associated abdominal injuries were common but did not influence operations on the pancreas (p > 0.05). No deaths were attributed to the pancreatic injury. These data indicate that early intervention for pancreatic injury, in the absence of clinical deterioration or major ductal injury (grades III, IV, or V), is unwarranted, and careful observation may supplant the conventional surgical therapy recommended for adults.
许多患有腹部实体器官损伤的成年人和大多数儿童可以采用非手术治疗。然而，迄今为止，关于胰腺损伤非手术治疗的结果知之甚少。为了分析儿童胰腺损伤的当前治疗模式，我们回顾了国家儿科创伤登记处（49540例患者）中所有年龄小于19岁、并被两所一级儿科创伤中心收治且诊断为胰腺损伤（国际疾病分类-9编码863.81 - 863.84和863.91 - 863.94）的儿童。在7年期间，共识别出154例胰腺损伤儿童。其中31例（20%）为重伤（Ⅲ、Ⅳ或Ⅴ级），123例（80%）为轻伤（Ⅰ和Ⅱ级）。Ⅲ、Ⅳ或Ⅴ级损伤的儿童中有16例（52%）需要进行胰腺手术（9例远端切除术、3例单纯修补术、2例肠吻合术、2例其他手术）。Ⅰ和Ⅱ级损伤中只有26例（21%）需要针对胰腺进行手术干预（11例切除术、9例假性囊肿导管引流术、2例肠吻合术、4例其他手术）。97例（79%）Ⅰ和Ⅱ级损伤通过保守治疗成功处理。总体而言，15例（10%）儿童需要进行假性囊肿引流手术。在研究的最后4年中，手术干预的频率有所下降（18%对26%，p>0.05），这与假性囊肿引流手术频率的下降相吻合。手术干预的必要性不受年龄、损伤严重程度评分或儿科创伤评分的影响（p>0.05）。相关的腹部损伤很常见，但不影响胰腺手术（p>0.05）。没有死亡病例归因于胰腺损伤。这些数据表明，在没有临床病情恶化或主要导管损伤（Ⅲ、Ⅳ或Ⅴ级）的情况下，对胰腺损伤进行早期干预是不必要的，仔细观察可能会取代推荐给成年人的传统手术治疗方法。
