Yang W B, Li L, Chen H, Kong R, Wang G, Tan H T, Wang Y W, Liu J, Wu L F, Jiang H C, Sun B
Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Key Laboratory of Hepatosplenic Surgery (Harbin Medical University) Ministry of Education, Harbin 150001, China.
Zhonghua Wai Ke Za Zhi. 2019 Sep 1;57(9):660-665. doi: 10.3760/cma.j.issn.0529-5815.2019.09.004.
To summarize the experience of treatment for blunt pancreatic trauma. The clinical data of 52 patients with blunt pancreatic trauma admitted to the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2018 were analyzed retrospectively.There were 40 male and 12 female patients, aging from 12 to 112 years with a median age of 35.5 years.According to the organ injury scale by American Association for the Surgery of Trauma(AAST) for pancreatic injury severity, 15 cases were in grade Ⅰ(28.8%), 20 cases were in grade Ⅱ(38.5%), 10 cases were in grade Ⅲ(19.2%),5 cases were in grade Ⅳ(9.6%) and 2 cases were in grade Ⅴ(3.8%). Isolated blunt pancreatic trauma occurred in 11(21.2%) patients including 5 cases of grade Ⅰ,5 cases of grade Ⅱ and 1 case of grade Ⅲ, and associated injuries existed in 41 patients(78.8%). Among 52 patients, 36 patients(69.2%) were transferred from other hospitals and 16(30.8%) patients were admitted through the emergency department. Finally, 49 patients(94.2%) were cured and 3 patients (5.8%) died.For the 15 cases of grade Ⅰ,9 patients were managed non-operatively, 5 cases underwent peritoneal lavage and drainage after surgery for the other injured abdominal organs, and 1 patient received percutaneous catheter drainage(PCD) with non-operative treatment. For the 20 cases of grade Ⅱ,4 cases only received non-operative treatment and 2 cases also received PCD. Besides, 2 cases underwent debridement and drainage for peripancreatic necrotic tissue and external drainage for pancreatic pseudocyst retrospectively after about 25 days of getting injured. As for patients who received exploratory laparotomy, 5 patients underwent suture repair associated with external drainage, and 7 patients were managed only with external drainage. For the 10 cases of grade Ⅲ,6 patients were cured through distal pancreatectomy and splenectomy with external drainage, while 2 patients underwent endoscopic retrograde cholangiopancreatography and ductal stenting, and the other 2 patients just received debridement and drainage for peripancreatic necrotic tissue.For the 5 cases of grade Ⅳ,2 patients underwent jejunostomy and abdominal cavity drainage, 1 patient had a pancreaticoduodenectomy with drainage,1 patient received suture repair of the pancreas and pancreaticojejunostomy, and 1 patient was managed with suture repair of the head of pancreas and external drainage.For the 2 patients of grade Ⅴ,1 patient received exploratory laparotomy and gauze compression packing hemostasis, and the other patient underwent pancreaticoduodenal repair, gastrointestinal anastomosis, duodenal exclusion surgery and external drainage. According to the AAST classifications, associated injuries, physiological status and intraoperative situation, it could be better to make a comprehensive judgment, achieve early diagnosis and take appropriate individualized treatment strategy, and to improve the overall therapeutic effect for blunt pancreatic trauma.
总结钝性胰腺损伤的治疗经验。回顾性分析2013年1月至2018年6月哈尔滨医科大学附属第一医院胰胆外科收治的52例钝性胰腺损伤患者的临床资料。患者中男性40例,女性12例,年龄12~112岁,中位年龄35.5岁。根据美国创伤外科学会(AAST)的器官损伤分级标准评估胰腺损伤严重程度,Ⅰ级15例(28.8%),Ⅱ级20例(38.5%),Ⅲ级10例(19.2%),Ⅳ级5例(9.6%),Ⅴ级2例(3.8%)。单纯钝性胰腺损伤11例(21.2%),其中Ⅰ级5例,Ⅱ级5例,Ⅲ级1例;合并其他损伤41例(78.8%)。52例患者中,36例(69.2%)由外院转入,16例(30.8%)经急诊入院。最终,49例(94.2%)治愈,3例(5.8%)死亡。Ⅰ级15例中,9例非手术治疗,5例因合并其他腹部脏器损伤术后行腹腔灌洗引流,1例非手术治疗同时行超声引导下经皮置管引流(PCD)。Ⅱ级20例中,4例仅行非手术治疗,2例加用PCD。另外,2例伤后约25 d分别行胰周坏死组织清创引流及胰腺假性囊肿外引流术。行剖腹探查术的患者中,5例行缝合修补加外引流,7例仅行外引流。Ⅲ级10例中,6例行胰体尾切除加脾切除加外引流治愈,2例行内镜逆行胰胆管造影及胆管支架置入术,另2例行胰周坏死组织清创引流。Ⅳ级5例中,2例行空肠造瘘加腹腔引流,1例行胰十二指肠切除加引流,1例行胰腺缝合修补加胰空肠吻合术,1例行胰头缝合修补加外引流。Ⅴ级2例中,1例行剖腹探查纱布填塞止血,另1例行胰十二指肠修补、胃肠吻合、十二指肠旷置术加外引流。根据AAST分级、合并伤情况、生理状态及术中情况综合判断,早期诊断并采取个体化治疗策略,可提高钝性胰腺损伤的整体治疗效果。