Patton J H, Lyden S P, Croce M A, Pritchard F E, Minard G, Kudsk K A, Fabian T C
Department of Surgery, University of Tennessee, Memphis, USA.
J Trauma. 1997 Aug;43(2):234-9; discussion 239-41. doi: 10.1097/00005373-199708000-00005.
Recent literature supports a conservative trend in the management of pancreatic injuries. Contrary to this trend, some recommend defining ductal integrity by pancreatography, implying that the results alter management. This study examines our recent 5-year experience with a simplified approach to all pancreatic injuries.
Retrospective analysis of patients sustaining pancreatic injuries was performed.
One hundred thirty-four patients were identified. Overall mortality was 13%, and pancreatic-related mortality was 2%. Analyses were based on 124 pancreatic injuries among patients who survived >12 hours. Thirty-seven proximal injuries were treated with drainage alone, with a pancreatic morbidity of 11%. Eighty-seven distal pancreatic injuries occurred, 54 with indeterminate ductal status. Twenty-four had high probability for duct injury and were treated by distal resection; 30 with a low probability of ductal injury were drained. Pancreatic morbidity was not different between these groups.
Pancreatic injuries including those with indeterminate ductal status can be successfully managed with low morbidity and mortality using this simplified management protocol.
近期文献支持在胰腺损伤处理上采取保守趋势。与这一趋势相反，一些人建议通过胰管造影来确定胰管完整性，这意味着其结果会改变治疗方式。本研究探讨了我们近5年对所有胰腺损伤采用简化方法的经验。
对胰腺损伤患者进行回顾性分析。
共确定了134例患者。总体死亡率为13%，胰腺相关死亡率为2%。分析基于124例存活超过12小时患者的胰腺损伤情况。37例近端损伤仅行引流治疗，胰腺并发症发生率为11%。发生了87例远端胰腺损伤，54例胰管情况不明。24例胰管损伤可能性高，接受了远端切除术；30例胰管损伤可能性低，进行了引流。这些组之间的胰腺并发症无差异。
使用这种简化的治疗方案，包括胰管情况不明的胰腺损伤，都能以低发病率和死亡率成功处理。
