早期鼻胰管引流联合最小化手术治疗钝性重度胰腺创伤
Combination therapy with early nasopancreatic drainage and minimum surgery for blunt high-grade pancreatic trauma.
作者信息
Takaoka Makoto, Ono Masayoshi, Kunishige Chika, Tohma Yoshiki
机构信息
Himeji Emergency Trauma and Critical Care Center Steel Memorial Hirohata Hospital Himeji Hyogo Japan.
Acute Care Medical Center Hyogo Prefectural Kakogawa Medical Center Kakogawa Hyogo Japan.
出版信息
Acute Med Surg. 2014 May 19;1(4):238-241. doi: 10.1002/ams2.51. eCollection 2014 Oct.
CASE
A 22-year-old man suffered blunt, high-grade, pancreatic trauma; however, duct-related complications were avoided by combining early nasopancreatic drainage with minimal surgery. Endoscopic retrograde pancreatography confirmed rupture of the main pancreatic duct and massive retroperitoneal extravasation. A nasopancreatic catheter was placed across the rupture site, laparotomy was carried out, and a grade IV pancreatic head laceration was sutured. Because the nasopancreatic catheter shifted out intraoperatively, another was inserted and left in place for 12 days.
OUTCOME
The patient recovered well without any duct-related complications such as pseudocyst or external pancreatic fistula.
CONCLUSION
A combination of early therapeutic endoscopic retrograde pancreatography and surgical repair may be useful for treating high-grade pancreatic trauma when pancreatic resection is unnecessary.
病例
一名22岁男性遭受钝性、重度胰腺创伤；然而，通过早期鼻胰管引流与最小化手术相结合，避免了与导管相关的并发症。内镜逆行胰胆管造影证实主胰管破裂和大量腹膜后渗出。一根鼻胰管经破裂部位置入，进行了剖腹手术，对IV级胰头裂伤进行了缝合。由于术中鼻胰管移位，又插入了一根并留置12天。
结果
患者恢复良好，未出现任何与导管相关的并发症，如假性囊肿或胰外瘘。
结论
当无需进行胰腺切除时，早期治疗性内镜逆行胰胆管造影与手术修复相结合可能有助于治疗重度胰腺创伤。
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