闭合性胰腺创伤的临床诊断和治疗研究进展OA北大核心CSTPCD

Blunt pancreatic trauma is not common.Its imaging manifestations are inconspicuous,the concomitant multiple organ injuries often mask each other,and clinical signs are ambiguous,making diagnosis challenging,prone to misdiagnosis or missed diagnosis,resulting in a high mortality rate.The diagnosis of blunt pancreatic trauma should be based on imaging evidence,laboratory tests,comprehensive injury history,and clinical manifestations.Treatment depends on the level and location of the trauma.For low-grade trauma with hemodynamic stability,non-surgical treatment is usually adopted,including fasting,total parenteral nutrition,somatostatin application,acid-suppression therapy,external drainage,pancreatic duct stenting,repeat imaging examinations,and actively managing complications and comorbidities based on the patient's specific condition;non-surgical treatment is generally not recommended for hemodynamically unstable patients.Surgery of high-grade trauma is challenging.Usually,according to the principle of damage control,the pros and cons of the patient's injury severity,physiological state and actual intraoperative situation are weighed,and the appropriate individualized treatment strategy is selected according to the actual capability of the treatment center,with the option of transferring to a regional pancreatic center if necessary.Common complications after blunt pancreatic trauma include pseudocyst and pancreatic fistula.Early use of somatostatin should be employed after surgery to reduce secretion of pancreatic juice and prevent pancreatic fistula.Additionally,percutaneous drainage,endoscopic stent placement,and endoscopic cyst-gastrostomy or cyst-jejunostomy can be used for management.Pseudocyst formation in the pancreas is mainly due to poor postoperative drainage,which can be cured by proper irrigation and puncture catheter drainage,and rarely requires further surgery.The authors elucidate the clinical diagnosis and treatment of blunt pancreatic trauma by combining previous research literature and the treatment experience of their center,aiming to help improve the early diagnosis rate of blunt pancreatic trauma and provide more rational treatment.