Diagnosis and treatment of pancreatic trauma
10.3877/cma.j.issn.2095-3232.2016.01.013
- VernacularTitle:胰腺损伤的诊断与治疗
- Author:
Di TANG
1
;
Xiaoxu ZHU
;
Weiling HE
;
Xiaoyu YIN
;
Lijian LIANG
Author Information
1. 中山大学附属第一医院胆胰外科
- Keywords:
Pancreas;
Injuries;
Diagnosis;
Therapeutics
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2016;5(1):51-55
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the diagnosis and treatment experiences for pancreatic trauma. Methods Clinical data of 25 patients with pancreatic trauma admitted to the First Affiliated Hospital of Sun Yat-sen University from August 2003 to July 2014 were retrospectively analyzed. There were 17 males and 8 females, with age ranging from 7 to 54 years and a median age of 26 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. According to the scale of American Association for the Surgery of Trauma (AAST) for pancreatic trauma, 3 cases were classiifed as gradeⅠ, 9 as gradeⅡ, 7 as gradeⅢ, 5 as gradeⅣand 1 as gradeⅤ. The diagnosis, treatment and prognosis of the patients were observed. Results Two patients were observed with consciousness disorders and the other 23 suffered from acute abdominal pain of varying extent. Elevated serum amylase was observed in 63% (15/24) of the cases. Seven cases were observed with increasing amylase via abdominocentesis before operation. Seventeen cases underwent preoperative ultrasound examination and the rate of conifrmed diagnosis was 41%(7/17). Fourteen cases underwent preoperative CT scan and the rate of conifrmed diagnosis was 71%(10/14). Three grade I cases underwent peripancreatic drainage alone. Among the 9 cases of gradeⅡ, 2 received conservative therapy, 6 underwent peripancreatic drainage and 1 received pancreatic rupture repair. Among the 7 cases of gradeⅢ, 4 underwent proximal pancreatic stump closure+distal pancreaticojejunostomy, 2 underwent distal pancreatectomy with splenectomy and 1 underwent distal pancreatectomy alone. Among the 5 cases of gradeⅣ, 4 underwent proximal pancreatic stump closure+distal pancreaticojejunostomy and 1 underwent proximal pancreatic stump closure+distal pancreaticogastrostomy. One case of gradeⅤunderwent pancreatic necrosectomy+duodenorrhaphy+peripancreatic drainage. Of the 25 patients, 2 death case were observed, 6 developed pancreatic ifstula and 5 developed pancreatic pseudocyst after operation. One patient with pancreatic ifstula was cured after receiving pancreatic duct stent drainage by endoscopic retrograde cholangiopancreatography (ERCP). Two patients with pancreatic pseudocyst were cured after undergoing cyst drainage. The other patients with pancreatic ifstula and pseudocyst were cured after undergoing ultrasound-guided puncture drainage. Conclusions Increasing amylase in the serum and lfuid by abdominocentesis before operation can be regarded as indicators of pancreatic trauma. Preoperative CT scan is of certain signiifcance in the diagnosis and classifying the pancreatic trauma. Surgical operation for pancreatic trauma should be selected according to the types, grades of trauma and related complications.
