在高度的胰腺和十二指肠创伤中进行胰腺双管切除术
Soroosh Noorbakhsh1, Victoria Wagner1, Vanessa Arientyl1
1Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30307, United States; Grady Memorial Hospital, 80 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States.
Injury
|July 31, 2024
概括
高度的胰腺双关节损伤很罕见,但致命. 胰腺双管切除术 (Whipple手术) 在选定的患者中是可行的,通常是在损伤控制手术后,存活时间取决于受伤严重程度和患者状况.
科学领域:
- 创伤外科 手术 创伤外科
- 手术瘤学手术瘤学
- 胃肠道手术 胃肠道手术
背景情况:
- 高度的胰腺双关节损伤具有显著的发病率和死亡率.
- 管理通常需要复杂的外科干预,包括惠普尔手术.
- 缺乏关于在创伤中使用Whipple程序的既定指导方针.
研究的目的:
- 评价14年的经验,在管理高等级的胰腺双损伤.
- 评估在创伤患者中使用Whipple手术的可行性和结果.
- 分析患者的人口统计,损伤模式和管理策略.
主要方法:
- 对患有高度 (AAST-OIS等级IV和V) 胰腺或十二指肠损伤的患者 (>15年) 的回顾性评估.
- 包括标准:高度伤害和外科医生确定需要Whipple手术.
- 直接接受Whipple和Whipple候选患者 (分期,死亡或挽救) 之间的结果比较.
主要成果:
- 在66272例创伤病例中,有20名患者符合纳入标准.
- 六名患者立即接受了Whipple手术;14人是Whipple候选人 (7人分期,6人死亡,1人得救).
- 枪伤占伤害的95%;常见的并发伤害包括主要血管 (75%),结肠 (65%) 和肝脏 (60%). 在Whipple患者的住院死亡率为15%.
结论:
- 需要Whipple手术的复杂的胰腺腹损伤是罕见的,并可能危及生命.
- 出血是24小时内早期死亡的主要原因.
- 初始胰腺双管切除术对于精选的患者是可行的,取决于损伤程度,生理状态和复苏努力.
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