Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan, ROC.
Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC.
Surg Endosc. 2017 Oct;31(10):4201-4210. doi: 10.1007/s00464-017-5478-0. Epub 2017 Mar 9.
To evaluate the management and outcomes of blunt pancreatic injuries based on the integrity of the major pancreatic duct (MPD).
Between August 1996 and August 2015, 35 patients with blunt pancreatic injuries underwent endoscopic retrograde pancreatography (ERP). Medical charts were retrospectively reviewed for demography, ERP timing, imaging findings, management, and outcome.
Of the 35 patients, 21 were men and 14 were women, with ages ranging from 11 to 70 years. On the basis of the ERP findings, we propose a MPD injury classification as follows: class 1 indicates normal MPD; class 2, partial injury with intact MPD continuity; and class 3, complete injury with disrupted MPD continuity. Both classes 2 and 3 are subdivided into classes a, b, and c, which represent the pancreatic tail, body, and head, respectively. In this report, 14 cases belonged to class 1, 10 belonged to class 2, and 11 belonged to class 3. Of the 14 patients with class 1 injuries, 10 underwent nonsurgical treatment and 4 underwent pancreatic duct stenting. Of the 10 patients with class 2 injuries, 4 underwent nonsurgical treatment and 6 underwent pancreatic duct stenting. Two of the 11 patients with class 3 injuries underwent pancreatic duct stenting; one in the acute stage developed sepsis that led to death even after converting to distal pancreatectomy plus splenectomy. Of the 11 patients with class 3 injuries, spleen-preserving distal pancreatectomy was performed in 6, distal pancreatectomy plus splenectomy in 2, and Roux-en-Y pancreaticojejunostomy after central pancreatectomy in 2. The overall pancreatic-related morbidity rate was 60% and the mortality rate was 2.8%.
Based on our experience, class 1 and 2 injuries could be treated by nonsurgical means and pancreatic duct stenting could be an adjunctive therapy in class 2b and 2c injuries. Operation is warranted in class 3 injuries.
本研究旨在评估基于主胰管（MPD）完整性的钝性胰腺损伤的处理方法和结果。
1996 年 8 月至 2015 年 8 月期间，35 例钝性胰腺损伤患者接受了内镜逆行胰胆管造影术（ERP）。回顾性分析患者的人口统计学资料、ERP 时机、影像学表现、处理方法和结局。
35 例患者中，21 例为男性，14 例为女性，年龄 11~70 岁。根据 ERP 结果，我们提出了 MPD 损伤分类如下：1 类表示 MPD 正常；2 类表示 MPD 连续性部分受损；3 类表示 MPD 连续性完全受损。2 类和 3 类均进一步分为 a、b 和 c 亚类，分别代表胰尾、体和头部。本报告中，14 例为 1 类，10 例为 2 类，11 例为 3 类。14 例 1 类损伤患者中，10 例接受非手术治疗，4 例接受胰管支架置入术。10 例 2 类损伤患者中，4 例接受非手术治疗，6 例接受胰管支架置入术。2 例 3 类损伤患者接受胰管支架置入术；1 例在急性期发生脓毒症，即使转为远端胰腺切除术加脾切除术，仍导致死亡。11 例 3 类损伤患者中，6 例行保留脾脏的远端胰腺切除术，2 例行远端胰腺切除术加脾切除术，2 例行胰体中部切除后行 Roux-en-Y 胰肠吻合术。总的胰腺相关并发症发生率为 60%，死亡率为 2.8%。
根据我们的经验，1 类和 2 类损伤可采用非手术方法治疗，胰管支架置入术可作为 2b 类和 2c 类损伤的辅助治疗方法。3 类损伤需要手术治疗。
