Diagnosis and management of blunt pancreatic ductal injury in the era of high-resolution computed axial tomography
Diagnosis and management of blunt pancreatic ductal injury in the era of high-resolution computed axial tomography
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DOI：
10.1016/j.amjsurg.2006.12.024
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发表时间：
2007-05-01
影响因子：
3
通讯作者：
Mayberry, John C.
中科院分区：
文献类型：
--
作者：
Teh, Swee H.;Sheppard, Brett C.;Mayberry, John C.
背景：钝性胰腺导管损伤是一种罕见但潜在的病态损伤，可能难以诊断和治疗。计算机轴向断层扫描 (CAT) 扫描历来对于检测导管损伤并不可靠，但高分辨率 CAT 的出现应该会提高诊断准确性。 方法：根据我们前瞻性维护的创伤登记，对 1995 年 1 月至 2004 年 12 月期间诊断为钝性胰腺损伤且随后进行或未进行剖腹手术的连续患者进行回顾性审查。胰管损伤仅采用远端胰腺切除术(DPR)治疗，不辅助内镜逆行胰胆管造影或磁共振胰胆管造影。结果：50例钝性胰腺损伤患者中，33例同时接受了术前CAT扫描和剖腹探查。尽管 CAT 扫描解释和手术结果仅在 55% 的病例中与所有胰腺损伤精确对应，但 CAT 扫描对于识别胰腺导管损伤的敏感性为 91%，特异性为 91%。 11 名确诊胰管损伤的患者。接受了 DPR。幸存者中无术后胰腺相关死亡，仅有 1 例胰腺相关并发症，即 1 例低输出量胰瘘患者，5 周后痊愈。 结论：术前 CAT 扫描可以准确诊断钝性胰管损伤，无需辅助内镜逆行胰胆管造影或磁共振胰胆管造影，并且 DPR 可以有效、安全地治疗。 (c) 2007 Excerpta Medica Inc. 保留所有权利。
Background: Blunt pancreatic ductal injury is an uncommon but potentially morbid injury that can be difficult to diagnose and manage. Computed axial tomography (CAT) scan has historically been unreliable for the detection of ductal injury, but the advent of high-resolution CAT should improve diagnostic accuracy.Methods: From our prospectively maintained trauma registry, consecutive patients who had a diagnosis of blunt pancreatic injury with or without a subsequent laparotomy during the time, period from January 1995 through December 2004 were retrospectively reviewed. Pancreatic ductal injury was treated exclusively with distal pancreatic resection (DPR) without adjunctive endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography.Results: Of 50 patients with blunt pancreatic injury, 33 patients had both preoperative CAT scan and laparotomy. Although the CAT scan interpretation and operative findings corresponded precisely for all pancreatic injuries in only 55% of cases, CAT scan was 91 sensitive and 91% specific for identifying pancreatic ductal injury. Eleven patients with confirmed pancreatic ductal injury. underwent DPR. There were no postoperative pancreas-related deaths and only 1 pancreas-related complication among survivors, a patient with a low-output pancreatic fistula that resolved after 5 weeks.Conclusions: Blunt pancreatic ductal injury may be accurately diagnosed with preoperative CAT scan, without adjunctive endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography, and is effectively and safely treated with DPR. (c) 2007 Excerpta Medica Inc. All rights reserved.