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2003, Número 4

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Cir Gen 2003; 25 (4)


Conducta y tratamiento quirúrgico de las lesiones pancreáticas (Parte I)

Asensio JA, García JC, Petrone P, Roldán G, Pardo M, García WM, Karsidag T, Pak-art R, Kuncir E

Idioma: Español
Referencias bibliográficas: 62
Paginas: 349-358
Archivo PDF: 120.33 Kb.


RESUMEN

Propósito: Revisar algunos aspectos importantes acerca de la conducta y el tratamiento quirúrgico de las lesiones del páncreas.
Obtención de la información: Se revisó la mayor parte de la literatura obtenible acerca del tema (62 referencias).
Selección de los estudios: Se realizó un análisis crítico de cada artículo obteniendo información acerca de la historia, anatomía, frecuencia, mecanismos de lesión, lesiones asociadas y localización anatómica de la lesión.
Sede: Hospital de tercer nivel de atención.
Resultados: La laparotomía exploradora se empleó por vez primera en 1836, pero la primera exploración abdominal se realizó durante la Primera Guerra Mundial en 1914. El caso más antiguo registrado de lesión pancreática fue descrito en 1827, en Londres, Inglaterra; en 1868 se hizo, en Alemania, la primera resección de un segmento protuido de páncreas. En 1887, Senn publicó una monografía: “Cirugía del páncreas”, en ella aseveró “la absoluta necesidad del tratamiento quirúrgico de las heridas penetrantes del páncreas”. Las dos grandes guerras mundiales y las guerras de baja intensidad (Corea y Vietnam), dieron pábulo al desarrollo en la cirugía de trauma y con ella a la de páncreas. La frecuencia de lesiones del páncreas, en conflictos bélicos va de 0.2% (Primera Guerra Mundial) al 2.3% (Guerra de Corea); en la vida civil oscila de 0.2% a 6%. Respecto a las lesiones asociadas el hígado es el órgano más afectado con una frecuencia del 19%, y la localización más frecuente son la cabeza y el cuello del páncreas con un 37%. La mortalidad por lesión traumática puede ser hasta del 23%.
Conclusión: El páncreas, por su localización, su constitución anatómica y su pobre expresión sintomática resulta ser poco afectado, pero altamente letal cuando lo es.


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