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1、胰腺外伤的诊治体会概论胰腺和十二指肠损伤约占所有创伤性腹部损伤的3%-5%；闭合性胰外伤在腹部外伤中占比1%－5%，开放性腹部外伤占比12%；早期症状和体征隐匿，各种辅助检查缺乏特异性；漏诊率、误诊率高。AsensioJA,FelicianoDV,BrittLD,KersteinMD.Managementofduodenalinjuries.CurrProblSurg1993;30:1023.损伤机制在十二指肠和胰腺的钝挫伤中，约75%-85%是由机动车碰撞导致的；其余的十二指肠和胰腺钝性损伤是因坠落和打击引起的；另外，刀刺伤、枪
2、击伤等亦是导致胰腺损伤的常见原因。AsensioJA,FelicianoDV,BrittLD,KersteinMD.Managementofduodenalinjuries.CurrProblSurg1993;30:1023AsensioJA,DemetriadesD,HanpeterDE,etal.Managementofpancreaticinjuries.CurrProblSurg1999;36:325.IlahiO,BochicchioGV,ScaleaTM.Efficacyofcomputedtomographyinth
3、ediagnosisofpancreaticinjuryinadultblunttraumapatients:asingle-institutionalstudy.AmSurg2002;68:704.损伤分级目前使用最广的创伤分级系统是由美国创伤外科协会(AmericanAssociationfortheSurgeryofTrauma,AAST)制定的。虽然对损伤的处理并不完全与分级有关，但损伤分级可提供一种就损伤的严重程度进行沟通的实用方法。MooreEE,CogbillTH,MalangoniMA,JurkovichGJ,Ch
4、ampionHR,GennarelliTA,McAninchJW,PachterHL,ShackfordSR,TraftonPG.Organinjuryscaling,II:Pancreas,duodenum,smallbowel,colon,andrectum.JTrauma1990;30:1427-1429PMID:2231822AAST胰腺损伤分级:Ⅰ级：轻微挫伤不伴胰管损伤，或浅表撕裂伤不伴胰管损伤Ⅱ级：严重挫伤不伴胰管损伤或组织缺失，或严重撕裂伤不伴胰管损伤或组织缺失Ⅲ级：胰腺远端横断或实质/胰管损伤Ⅳ级：胰腺近端横断或
5、累及壶腹部的实质损伤Ⅴ级：胰头广泛断裂MooreEE,CogbillTH,MalangoniMA,JurkovichGJ,ChampionHR,GennarelliTA,McAninchJW,PachterHL,ShackfordSR,TraftonPG.Organinjuryscaling,II:Pancreas,duodenum,smallbowel,colon,andrectum.JTrauma1990;30:1427-1429PMID:2231822损伤分级此外，还有在1997年提出的CT影像分级；WongYC,WangL
6、J,LinBC,ChenCJ,LimKE,ChenRJ.CTgradingofbluntpancreaticinjuries:predictionofductaldisruptionandsurgicalcorrelation.JComputAssistTomogr1997;21:246-250PMID:9071293损伤分级2000年提出的ERCP影像分级；TakishimaT,HirataM,KataokaY,AsariY,SatoK,OhwadaT,KakitaA.Pancreatographicclassification
7、ofpancreaticductalinjuriescausedbybluntinjurytothepancreas.JTrau-ma2000;48:745-751;discussion751-752PMID:10780612IlahiO,BochicchioGV,ScaleaTM.Efficacyofcomputedtomographyinthediagnosisofpancreaticinjuryinadultblunttraumapatients:asingle-institutionalstudy.AmSurg2002;6
8、8:704-77;discussion704-77[PMID:12206605]针对AAST分级的治疗流程SharpeJP,MagnottiLJ,WeinbergJA,etal.Impactofadenedmanagementalgorithmon
