Department of Surgery, Yonsei University, Wonju College of Medicine, Republic of Korea.
Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Republic of Korea.
Int J Surg. 2017 Jun;42:152-157. doi: 10.1016/j.ijsu.2017.03.054. Epub 2017 Mar 22.
Traumatic pancreatic injuries are rare and present diagnostic and therapeutic difficulties. We evaluated the usefulness of endoscopic retrograde pancreatography and transpapillary pancreatic stent in the diagnosis and treatment of pancreatic trauma patients.
We reviewed medical records of 83 pancreas trauma patients who underwent endoscopic retrograde pancreatography for the suspicion of pancreas duct injury between January 1983 and December 2016. Patient notes, radiologic findings, laboratory investigations, operative records, and endoscopic retrograde pancreatography reports were reviewed.
Pre-endoscopic retrograde pancreatography abdominal computed tomography was performed in 52 patients. Twenty-seven patients of them were diagnosed with a major pancreatic duct injury by subsequent endoscopic retrograde pancreatography. Eleven major pancreatic duct injuries (40.7%) were missed by the pre-endoscopic retrograde pancreatography abdominal CT. Major pancreatic duct injury was confirmed by endoscopic retrograde pancreatography in 43 patients. These 43 major pancreatic duct injury patients were classified into the Operative (n = 21), Stent (n = 15), and Conservative (n = 7) groups according to the first treatment modality which was chosen by attending surgeon. Age, initial white blood cell count, initial serum amylase, associated injury, and major pancreatic duct injury site were similar among groups, while the rate of parenchymal leakage (Dye leakage confined to pancreatic capsule) on endoscopic retrograde pancreatography findings differed. Parenchymal leakage was most common in the Conservative group. Pancreas related mortality occurred in 1 (4.76%) Operative group, 2 (13.33%) Stent group, and 0 (0%) Conservative group. Pancreas related complication occurred in 16 (76.19%) Operative group, 10 (66.67%), Stent group and 5 (71.43%) Conservative group. There were no statistically significant differences in the occurrence rate of pancreas related complications and mortalities among three groups.
Endoscopic retrograde pancreatography helps clinicians choose a treatment modality for major pancreatic duct injury since it provides information about the precise condition of the major pancreatic duct injury. Endoscopic retrograde pancreatography with transpapillary pancreatic stenting also shows promise as a substitute for laparotomy or pancreatic resection in selected patients.
外伤性胰腺损伤较为罕见，诊断和治疗均存在一定难度。我们评估了内镜逆行胰胆管造影（ERCP）和经乳头胰管支架置入术在胰腺外伤患者诊断和治疗中的作用。
回顾性分析 1983 年 1 月至 2016 年 12 月期间 83 例胰腺外伤患者的临床资料，这些患者均因怀疑胰腺管损伤而行 ERCP 检查。查阅患者病历、影像学检查结果、实验室检查结果、手术记录和 ERCP 报告。
52 例患者术前行腹部 CT 检查，其中 27 例患者通过随后的 ERCP 检查诊断为主胰管损伤。11 例（40.7%）主胰管损伤在术前行腹部 CT 检查时漏诊。43 例患者通过 ERCP 检查确诊为主胰管损伤。根据术者选择的首次治疗方式，这 43 例主胰管损伤患者被分为手术治疗组（n=21）、支架治疗组（n=15）和保守治疗组（n=7）。3 组患者的年龄、白细胞计数、血清淀粉酶、合并伤及主胰管损伤部位差异无统计学意义，而 ERCP 检查结果中胰实质渗漏（胰实质内造影剂仅局限于胰腺包膜下）的发生率不同，胰实质渗漏在保守治疗组中最为常见。手术治疗组 1 例（4.76%）、支架治疗组 2 例（13.33%）和保守治疗组 0 例（0%）出现与胰腺相关的死亡。手术治疗组 16 例（76.19%）、支架治疗组 10 例（66.67%）和保守治疗组 5 例（71.43%）出现与胰腺相关的并发症。3 组患者胰腺相关并发症和死亡率的发生率差异无统计学意义。
ERCP 可提供主胰管损伤的确切情况，有助于临床医生为主胰管损伤患者选择治疗方式。对于部分患者，经乳头胰管支架置入术联合 ERCP 也可替代开腹手术或胰腺切除术。
