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中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 336 -339. doi: 10.3877/cma.j.issn.1674-3946.2023.03.026

综述

胰腺损伤临床救治及胰瘘预防研究进展
吕瑞昌1, 尚培中1,(), 李晓武1, 苗建军1, 刘冰1   
  1. 1. 075000 河北张家口,陆军第八十一集团军医院普通外科
  • 收稿日期:2023-01-03 出版日期:2023-06-26
  • 通信作者: 尚培中

Progress in clinical treatment of pancreatic injury and prevention of pancreatic fistula

Ruichang Lyu1, Peizhong Shang1,(), Xiaowu Li1, Jianjun Miao1, Bing Liu1   

  1. 1. Department of General Surgery,the 81st Group Army Hospital of PLA,Zhangjiakou Hebei Province 075000,China
  • Received:2023-01-03 Published:2023-06-26
  • Corresponding author: Peizhong Shang
  • Supported by:
    Zhangjiakou city key R & D project for comprehensive health and biomedicine(2021058D)
引用本文:

吕瑞昌, 尚培中, 李晓武, 苗建军, 刘冰. 胰腺损伤临床救治及胰瘘预防研究进展[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 336-339.

Ruichang Lyu, Peizhong Shang, Xiaowu Li, Jianjun Miao, Bing Liu. Progress in clinical treatment of pancreatic injury and prevention of pancreatic fistula[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(03): 336-339.

近年随着车辆事故、施工事故的增加,胰腺损伤发病率呈上升趋势。胰腺钝性闭合伤常合并其他脏器损伤,需通过动态多层螺旋CT(MSCT)、创伤超声重点评估法(FAST)协助诊断和综合评估,血清淀粉酶和脂肪酶升高具有一定临床指导价值。主要依据美国创伤外科协会制定的器官损伤分级(AAST-OIS)、合并其他脏器损伤情况、血流动力学状态3个方面选择治疗策略。树立胰瘘的三级预防思路,通过双套管持续负压灌洗和早期肠内营养支持,可显著减少胰瘘及其相关并发症。本文就胰腺损伤临床救治及胰瘘预防研究进展进行综述,以期为临床不断提高胰腺损伤治愈率提供参考。

In recent years,with the increase of vehicle accidents and construction accidents,the incidence of pancreatic injury is on the rise. Blunt pancreatic closure injury is often complicated with other organ injuries,and dynamic multi-slice spiral CT(MSCT)and Key assessment of trauma ultrasound(FAST)are needed to assist diagnosis and comprehensive evaluation. The increase of serum amylase and lipase has certain clinical guiding value. The treatment strategies were mainly selected based on three aspects:the organ injury classification(AAST-OIS),the combination of other organ injuries,and hemodynamic status formulated by the American Association for Traumatic Surgery. Pancreatic fistula and its related complications can be significantly reduced through continuous negative pressure lavage with double cannula and early enteral nutrition support. In this paper,the clinical treatment of pancreatic injury and the prevention of pancreatic fistula were reviewed,in order to provide reference for improving the clinical cure rate of pancreatic injury.

[1]
Kumar NSingh ADheer Y,et al. Pancreatic injury-a case series analysis from a levelⅠtrauma center[J]. Indian J Surg202183(S1):144-148.
[2]
Coccolini FKobayashi LKluger Y,et al. Duodeno-pancreatic and extrahepatic biliary tree trauma:WSES-AAST guidelines[J]. World J Emerg Surg201914:56.
[3]
Kuza CMHirji SAEnglum BR,et al. Pancreatic injuries in abdominal trauma in US adults:Analysis of the national trauma data bank on management,outcomes,and predictors of mortality[J]. Scand J Surg2020109(3):193-204.
[4]
Mulpuri VBBhuria DKRana S,et al. Spleen-preserving distal pancreatectomy following grade Ⅲ pancreatic injury in a delayed presentation:A technical challenge[J]. BMJ Case Rep202114(6):e242721.
[5]
Gupta VSingh SVKumar N,et al. Missed pancreatic injury in patients undergoing conservative management of blunt abdominal trauma:Causes,sequelae and management[J]. Turk J Surg202137(3):286-293.
[6]
Luu AMMeurer KHerzog T,et al. Diagnostic double strike in the emergency room- two cases of complete pancreatic ruptures due to bicycle handlebar injuries on two consecutive days[J]. J Med Case Rep201812(1):85.
[7]
Goldberg-Murow MSteiner ZLakovsky Y,et al. Blunt high-grade pancreatic injury in children:A 20-year experience in two pediatric surgical centers[J]. Isr Med Assoc J202123(3):180-185.
[8]
Kang WSPark YCJo YG,et al. Pancreatic fistula and mortality after surgical management of pancreatic trauma:Analysis of 81 consecutive patients during 11 years at a Korean trauma center[J]. Ann Surg Treat Res201895(1):29-36.
[9]
韩丽,陈思平,周世波,等. 人脐带间充质干细胞治疗胰腺损伤的研究进展[J]. 创伤外科杂志202224(07):550-555.
[10]
郭金坤,周中银. 不同检查方式对胰腺损伤的诊疗价值[J]. 肝胆胰外科杂志202133(10):637-641.
[11]
谭勇,吴黎明,朱剑华,等. 15例闭合性胰腺损伤的外科诊治分析[J]. 中国普外基础与临床杂志202229(10):1350-1354.
[12]
Ando YOkano KYasumatsu H,et al. Current status and management of pancreatic trauma with main pancreatic duct injury:A multicenter nationwide survey in Japan[J]. J Hepatobiliary Pancreat Sci202128(2):183-191.
[13]
Rau CSWu SCChien PC,et al. Identification of pancreatic injury in patients with elevated amylase or lipase level using a decision tree classifier:A cross-sectional retrospective analysis in a levelⅠtrauma center[J]. Int J Environ Res Public Health201815(2):277.
[14]
Al-Thani HRamzee AFAl-Hassani A,et al. Traumatic pancreatic injury presentation,management,and outcome:An observational retrospective study from a levelⅠtrauma center[J]. Front Surg20228:771121.
[15]
Liu PXiao ZYan H,et al. Serum amylase and lipase for the prediction of pancreatic injury in critically Ⅲ children admitted to the PICU[J]. Pediatr Crit Care Me202122(1):e10-e18.
[16]
陈宠,姚一帆,陈立奖,等. 血清淀粉酶和脂肪酶在腹部手术后胰腺损伤中的诊断价值[J]. 浙江创伤外科202126(01):80-82.
[17]
徐之超,赵刚,杜俊凯. 应重视创伤性胰腺炎的治疗[J]. 中华医学杂志2021101(30):2360-2362.
[18]
Joos EDe Jong NBall CG,et al. Time to operating room matters in modern management of pancreatic injuries:A national review on the management of adult pancreatic injury at Canadian level 1 trauma centers[J]. J Trauma Acute Care202190(3):434-440.
[19]
段寿生,黄洪,余强. CT在腹部闭合性胰腺损伤诊断中的应用[J]. 浙江创伤外科202025(04):772-773.
[20]
Iacobellis FLaccetti ETamburrini S,et al. Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma:A multicenter experience[J]. Gland Surg20198(2):184-196.
[21]
Hubbard CKocher MRHardie AD. The use of MRI digital subtraction technique in the diagnosis of traumatic pancreatic injury[J]. Radiol Case Rep201914(5):639-645.
[22]
吕瑞昌,尚培中,李晓武,等. 胰腺损伤77例临床诊治分析[J]. 河北北方学院学报(自然科学版)202339(04):24-29.
[23]
Soreide KWeiser TGParks RW. Clinical update on management of pancreatic trauma[J]. HPB(Oxford)201820(12):1099-1108.
[24]
Serra FBarbato GTazzioli G,et al. Pancreaticogastrostomy as reconstruction choice in pancreatic trauma surgery:Case report and review of the literature[J]. Int J Surg Case Rep201965:102-106.
[25]
刘杰,赵丽,宁刚. 闭合性胰腺损伤保守治疗的病例选择[J]. 黑龙江医学202246(15):1842-1844.
[26]
Ito KEndo AKobayashi M,et al. Severe pancreatic injury with total disruption of main pancreatic duct successfully managed by multi-stage endoscopic therapy:A case report[J]. Acute Med Surg20229(1):e735.
[27]
杨超,丁威威,孙世龙,等. 胰管支架联合经皮穿刺引流在胰腺外伤治疗中的应用[J]. 中华胰腺病杂志202121(02):129-131.
[28]
Kandori KIshii WIizuka R. Successful combination strategy of preoperative placement of an endoscopic nasopancreatic drainage catheter and pancreas preservation surgery for pancreatic injury with major pancreatic duct disruption:A case report[J]. Surg Case Rep20195(1):182.
[29]
Elinore JKCaitlin BFJennifer M,et al. Non-operative management of pancreatic injury[J]. J Pediatr Surg Case Rep202052(C):101352.
[30]
Lin BCHwang TL. Resection versus drainage in the management of patients with AAST-OIS grade Ⅳ blunt pancreatic injury:A single trauma centre experience[J]. Injury202153(1):129-136.
[31]
冯健,刘志伟,蔡守旺,等. Ⅲ、Ⅳ级胰腺钝性损伤微创治疗的探讨[J]. 中华肝胆外科杂志202127(12):909-912.
[32]
陆家樑,鲁葆春,方剑锋. 胰腺闭合性损伤致迟发性胆胰管狭窄1例报道[J]. 浙江医学202244(14):1547-1548,1559.
[33]
Chin KMKoh YXGoh BKP. Laparoscopic distal pancreatosplenectomy for isolated blunt traumatic pancreatic laceration:A case report and review of current literature[J]. Ann Hepatobiliary Pancreat Surg201923(4):408-413.
[34]
Lin BCChen RJHwang TL. Spleen-preserving versus spleen-sacrificing distal pancreatectomy in adults with blunt major pancreatic injury[J]. BJS Open20182(6):426-432.
[35]
Du BWang XWang X,et al. A rare case of central pancreatectomy for isolated complete pancreatic neck transection trauma[J]. BMC Surg201919(1):91.
[36]
Naiem MEAArabi NA. Isolated pancreatic injury in an adolescent treated with Roux-en-Y pancreatojejunostomy:A case report and review of the literature[J]. J Med Case Rep202115(1):474.
[37]
江宗兴,刘彦莉,肖乐,等. “桥接法”在闭合性椎前区胰腺损伤合并胰管断裂中的应用[J]. 创伤外科杂志201719(09):673-676.
[38]
Uchida KHagawa NMiyashita M,et al. How to deploy a uniform and simplified acute-phase management strategy for traumatic pancreatic injury in any situation[J]. Acute Med Surg20207(1):e502.
[39]
Hyser ESahhar HSWoollen C. Modified Whipple on an 18-month-old with traumatic pancreatic transection and duodenal rupture[J]. Trauma Case Rep201923:100241.
[40]
尚丹丹,刘燕,尚培中,等. 外伤性肝破裂的治疗现状[J]. 河北北方学院学报(自然科学版)202238(02):40-45.
[41]
吕瑞昌,尚培中,刘洋,等. 腹部大血管刀刺伤5例成功救治分析[J]. 河北北方学院学报(自然科学版)201935(10):35-36.
[42]
杨文博,李乐,陈华,等. 闭合性胰腺损伤的临床诊治分析[J]. 中华外科杂志201957(09):660-665.
[43]
吴祯乾,沈容荣,阎钧,等. 胰腺损伤的临床诊治[J]. 上海医药202142(18):3-7.
[44]
牛闻宇,支永发,张义,等. 全腹腔镜胰十二指肠切除术的预后研究[J/CD]. 中华普外科手术学杂志(电子版),202216(01):87-90.
[45]
刘月生,李国林,曾海锋,等. 不同胰肠吻合法在胰十二指肠切除术中的前瞻性对比研究[J/CD]. 中华普外科手术学杂志(电子版),202216(03):327-330.
[46]
陈龙江,李微波,汤志刚,等. 基于CT影像组学胰十二指肠切除术后胰瘘风险预测模型及其价值[J]. 肝胆胰外科杂志202234(11):667-673.
[47]
Ho VPPatel NJBokhari F,et al. Management of adult pancreatic injuries:A practice management guideline from the Eastern association for the surgery of trauma[J]. J Trauma Acute Care Surg201782(1):185-199.
[48]
尚培中. 胰十二指肠切除术后胰瘘的三级预防思路及措施[J/CD]. 中华普通外科学文献(电子版),20148(02):98-101.
[49]
尚培中,李晓武,苗建军,等. 胰十二指肠切除术改进胰肠及胃肠吻合方式52例观察[J/CD]. 中华普通外科学文献(电子版),20148(02):111-115.
[50]
沈连强,吴嘉,韩方,等. 胰十二指肠切除术后腹腔引流管的管理[J]. 肝胆胰外科杂志202234(11):664-666,673.
[51]
施思,项金峰,徐近,等. 2016版国际胰腺外科研究组术后胰瘘定义和分级系统更新内容介绍和解析[J]. 中国实用外科杂志201737(02):149-152.
[52]
郭晓华,李东平,李凯凌. 胰腺损伤诊治分析[J]. 中国社区医师202137(01):16-17.
[53]
刘水,姚小晓,刘泽锋,等. 不同胰管支架管引流方式对胰十二指肠切除术后短期并发症的影响[J]. 肝胆胰外科杂志202234(11):660-663.
[54]
陈青江,张书豪,章跃滨,等. 外引流治疗儿童胰腺假性囊肿疗效分析[J]. 中华小儿外科杂志202243(11):988-992.
[55]
李宇,丁泓帆,刘学民,等. 单中心55例胰腺损伤诊治方法及效果[J]. 中华肝胆外科杂志202026(08):615-619.
[56]
方斌,陈中朝,张宇华. 腹腔镜胃前壁切开入路假性囊肿-胃吻合术治疗胰腺假性囊肿的体会[J]. 肝胆胰外科杂志202032(04):211-214.
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