| Objective: To discuss how to make choices of therapeutic and operativemethods to pancreatic trauma（PT）.Methods: The clinica1data of18patients treated form2006、11～2011、11were retrospectively analyzed. The18patients included16male and2malepatients.The oldest48years old, the youngest patient was15years old, averageage of37.58years; In the18patients with pancreatic injury: open injury of3cases(16.67%),15cases(83.33%) of closed injury.3cases of open injury arestabbed; In the15cases of closed injury: traffic accident in8cases(53.34%),fighting violence injury in3cases (20%), fall injury in two cases (13.33%),crush injury in2cases (13.33%). After admission are accepted at the differentimaging studies, patients underwent emergency abdominal ultrasound,2cases(16.67%) prompts the pancreas to interrupt and peripancreatic fluid areas, mostprompt abdominal bloating, poor pancreatic reality;15patients who underwentabdominal CT examination,6cases (40.00%) prompted pancreatic damage andvisible abdominal organ injury;MRCP examination in2patients prompted thepancreatic duct rupture; Joint abdominal ultrasound and CT scan in8patients,suggesting pancreatic injury in two cases (25.00%);Joint abdominalultrasound and CT examination were eight cases, suggesting that pancreaticinjury in two cases (25.00%); Joint abdominal ultrasound, CT and MRCPexaminer two cases, two cases (100.00%) are prompted to pancreaticinjury.There were1grade I,6grade II,5grade III,4grade IV and2grade V injuries, according to The American Association for the Surgery of Trauma（AAST） classification system.18cases of pancreatic injury patients in thesurgery to confirm the diagnosis in6cases (33.33%),2cases (11.11%) openabdominal injury; more than12cases (66.67%) were found at laparotomy, andwere seen associated with other abdominal organ injury.18patients underwentsurgery, including clear pancreatic necrosis, peripancreatic drainage in5patients,3cases of pancreatic repair, the tail of the pancreas partial excisionof1cases，tail of the pancreas, splenectomy1cases, distal pancreatectomy、splenectomy in1cases；the pancreatic proximal suture、distal jejunum Roux-en-Y anastomosis4cases；the pancreaticoduodenal resection in1case.2casesof open injury is serious due to the time of admission for abdominal injury,hemodynamic very unstable, in accordance with the damage control surgeryconcept, Phase I of the surgery cholecystectomy, gastrostomy, jejunal fistula,biliary T-tube drainage of common bile duct stump ligation, the pancreas stumpdebridement hemostasis drainage, the Phase II surgery in digestive tractreconstruction.Results:17cases (94.44%) were cured,1case (5.56%) died.5cases ofpancreatic fistula in17cases (29.41%), intra-abdominal hemorrhage in1case(5.88%), traumatic pancreatitis (5.88%). Pancreatic fistula after adequatedrainage, inhibit pancreatic secretion, enhance nutritional support conservativetreatment after recovery; Intra-abdominal hemorrhage occlusion by digitalsubtraction angiography (DSA) points after transmission by blood transfusion,fluid, bleeding stopped after the use of hemostatic agents; traumatic pancreatitisby inhibiting pancreatic secretion, nutritional support and symptomatictreatment rehabilitation. The1cases of death due to multiple organ with abdominal injury associated with hemorrhagic shock on admission, anti-shocktreatment at the same time line of damage control surgery, but the hemorrhagicshock led to multiple organ failure and death.Conclusion：Pancreatic injury incidence is relatively low, the moredifficult, early diagnosis, preoperative combined abdominal ultrasound, CT,MRCP imaging studies to confirm the diagnosis of certain guiding role.Pancreatic injury than patients before surgery did not prompt the pancreasinjury, abdominal injury, surgery should seriously probe the pancreas,especially blunt abdominal injury. AAST classification to select a reasonablesurgical, operating in the fine technique and indwelling patency ofperipancreatic drainage is the key to the treatment of pancreatic injury. |
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