Pancreatic Injury 胰腺外傷

醫(yī)學(xué)詞匯注釋與簡要講解

edema 水腫

contusion 挫傷

laceration 裂傷

fracture 斷裂

Key facts

Definition:Laceration or edema of the pancreatic parenchyma after trauma.

Pancreatic injury occurs in about 1%-3% of patients after blunt trauma.

70% of adults and 15%-30% of children have associated injuries.

Liver and duodenum are frequent associated injuries.

Delay in diagnosis occurs because findings are overlooked or not visible in the multi-trauma patient.

Higher mortality occurs if there is delay in diagnosis.

Sensitivity of CT is less with pancreatic and bowel injury than for other intraabdominal injuries.

Types of injury：Contusion,laceration,fracture.

Mechanism of injury is thought to be compression of pancreas against the spine due to anterior compression of abdominal wall.

transection 橫貫性傷

Imaging findings

CT finding

Contusion or edema is seen as:(1)Focal area of lower density within the pancreas;(2)Focal area in which there is effacement of the pancreatic septations.

Laceration is seen as a discontinuity in part of the parenchyma.

Transection is seen as a laceration across the entire width of the pancreas.

Duct injury is not a CT diagnosis but may be suspected if a laceration extends to the duct and is almost certain in transection.

Secondary findings of injury include:(1)Blood in the anterior pararenal space;(2)Look for blood between the pancreas and splenic vein,which is normally apposed to the inferior surface of the pancreas;(3)Blood may surround the superior mesenteric artery (SMA) and superior mesenteric vein (SMV)/portal vein;(4)Fat stranding in the anterior pararenal space;(5)Thickening of the left anterior renal fascia.

contrast 對比劑

dome 頂、穹窿

胰腺導(dǎo)管損傷通常在CT 上無法顯示（除非裂傷延伸至導(dǎo)管），應(yīng)選擇ERCP 或MR 檢查

Imaging recommendations

Pancreatic injury is detected on contrast enhanced CT using 5 mm thick images and 5 mm image spacing,using an injection rate of at least 2.5 ml/s for 135-180 ml of contrast,and using a 75 s delay after beginning injection until starting the scan at the dome of the diaphragm.

Fig 1 Male,46-year old,abdominal trauma for 2 days.Pancreatic transection is noted with separation of the pancreatic head from the body(arrows).Blood fills the space between the head and body (frame).Blood is also noted in the anterior pararenal space.Fig 2 Female,17-year old,abdominal pain for 20 hours.Pancreatic contusion is seen as effacement of the septations in a focal area of the inferior portion of the body of the pancreas (arrows)

If injury is uncertain due to only secondary findings,it may be useful to rescan using thinner sections or reformat to thinner image thickness and spacing.Duct injury,which occurs in about 15% of patients with pancreatic injury,is not diagnosed with CT but may be demonstrated by ERCP (endoscopic retrograde cholangiopancreatography) or MRI.

分級用于傷情的判斷，有助于下一步治療的選擇

Pathology

Staging or grading criteria

American association for the surgery of trauma (AAST):(1)Type 1:Minor contusion,superficial laceration,duct intact;(2)Type 2:Major contusion,major laceration,duct intact;(3)Type 3:Duct injury,distal transection;(4)Type 4:Proximal transection,ampulla injury;(5)Type 5:Massive disruption of pancreatic head.

Lucas classification:(1)Type 1:Contusion;(2)Type 2:Transection anterior to spine;(3)Type 3:Laceration of pancreatic head;(4)Type 4:Injury of head and duodenum.

amylase 淀粉酶

應(yīng)正確認(rèn)識胰腺外傷時淀粉酶值的變化

Clinical issues

Amylase may initially be normal or abnormal.A normal amylase does not exclude pancreatic injury.An abnormal amylase does not necessarily indicate pancreatic injury.1-2 days after injury,the amylase will be elevated in 80%-90% of patients with pancreatic injury.

Weeks to years later the following may occur:(1)Recurrent pancreatitis;(2)Pancreatic abscess;(3)Hemorrhage;(4)Pseudocyst(s);(5)Fistulae to adjacent structures;(6)Duct stricture.

Treatment

Injury to the pancreatic duct constitutes a surgical emergency.

英文文字摘自Novelline RA,Rhea JT,Ptak T,et al.Pocket radiologist:ER-trauma:top 100 diagnoses.Salt Lake City:Amirsys Inc,2004:173-175.DOI：10.3969／j.issn.1005－8001.2021.01.017

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510080 廣東廣州，中山大學(xué)附屬第一醫(yī)院醫(yī)學(xué)影像科 關(guān)鍵 王珂 編寫