Kandori Kenji, Ishii Wataru, Iizuka Ryoji
Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026, Japan.
Surg Case Rep. 2019 Nov 21;5(1):182. doi: 10.1186/s40792-019-0743-1.
The guidelines recommend pancreatic resection for grade III and IV pancreatic injuries. On the other hand, organ preservation is an important issue. Herein, we present the first case of pancreatic injury with major pancreatic duct (MPD) disruption that was treated with the combination of preoperative placement of endoscopic nasopancreatic drainage (ENPD) catheter and pancreas preservation surgery after endoscopic pancreatic stenting (EPS) failure.
A 70-year-old female diagnosed with pancreatic injury was admitted to our hospital. She was hemodynamically stable. ERP revealed MPD disruption, and EPS failed. An ENPD catheter was placed preoperatively at the site of injury. During laparotomy, we identified a partial-thickness laceration in the pancreatic body. At the site of injury, the tip of the ENPD catheter was found; therefore, the patient was diagnosed with grade III pancreatic body injury with MPD disruption. The extent of crush was not severe, and we had no difficulty in identifying the distal MPD segment. We inserted the ENPD catheter into the distal MPD segment. The ruptured MPD and the laceration was sutured, then pancreatic resection was prevented. She was discharged on POD 56.
The treatment strategy incorporated ERP, placement of an ENPD catheter preoperatively, and a simple surgery in a hemodynamically stable patient with pancreatic injury allows the pancreas and spleen to be preserved.
指南推荐对Ⅲ级和Ⅳ级胰腺损伤行胰腺切除术。另一方面，器官保留是一个重要问题。在此，我们报告首例主胰管（MPD）断裂的胰腺损伤病例，该病例在内镜下胰管支架置入（EPS）失败后，采用术前放置内镜鼻胰引流（ENPD）导管与胰腺保留手术相结合的方法进行治疗。
一名70岁诊断为胰腺损伤的女性入住我院。她血流动力学稳定。内镜逆行胰胆管造影（ERP）显示MPD断裂，且EPS失败。术前在损伤部位放置了ENPD导管。剖腹手术时，我们发现胰体有部分厚度的撕裂伤。在损伤部位发现了ENPD导管的尖端；因此，该患者被诊断为Ⅲ级胰体损伤伴MPD断裂。挤压程度不严重，我们不难识别MPD远端节段。我们将ENPD导管插入MPD远端节段。对断裂的MPD和撕裂伤进行了缝合，从而避免了胰腺切除术。她于术后第56天出院。
对于血流动力学稳定的胰腺损伤患者，采用ERP、术前放置ENPD导管以及简单手术的治疗策略可保留胰腺和脾脏。
