Abstract:

Pancreatic trauma：diagnosis，grades and management              TIAN Xiao-dong，YANG Yin-mo. Department of General surgery，Peking University First Hospital，Beijing 100034，China
Corresponding author：YANG Yin-mo, E-mail：yangyinmo@263.net
Abstract    Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. The morbidity and mortality remain high. A high index of suspicion and appropriate treatment are essential to delineate the nature of the injury. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption，which is most easily seen on magnetic resonance cholangiopancreatography，endoscopic retrograde cholangiopancreaticography or intraoperative pancreatography. A full inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is main pancreatic duct disruption. Surgical treatment of pancreatic injury is complex and the first principle should be life salvage. Bleeding control，debridement of devitalized tissue and effective drainage are the main aims of surgery. The concept of staged damage control surgery should be employed for unstable patients. The optimal selection of procedure can help the patients to survive the first operation，to reduce the postoperative complications，and to have the chance to undergo the second laparotomy for reconstruction.

Key words: pancreatic trauma, pancreatic duct injury, grades of pancreatic injury

摘要：

胰腺损伤多合并有其他器官损伤，并发症发生率及病死率较高，及时诊断特别是正确的处理是改善胰腺损伤病人预后的关键。腹部增强CT对胰腺损伤最具诊断价值，但对胰管损伤的诊断缺乏特异性，磁共振胰胆管成像（MRCP）、内镜逆行胰胆管造影（ERCP）或术中胰管造影等有助于进一步确认胰管损伤情况。术中应注意对胰腺及十二指肠的充分探查，以免遗漏潜在的胰腺损伤。胰腺损伤分级对术式选择具有指导性，主胰管损伤是决定预后的主要因素。胰腺损伤处理的总体原则是生命第一，功能第二；总体目标是有效止血、清除失活胰腺组织和充分引流。对血流动力学不稳定的重症病人应遵循损伤控制理念，合理选择术式以挽救生命，减少并发症，并为可能的再次手术创造条件。

关键词: 胰腺损伤, 胰管损伤, 胰腺损伤分级