Clinical Prognostic Risk Factors Analysis Of Pancreatic Trauma And Experience Of Single-center Treatment

Objectives:Pancreatic injury is rare in abdominal trauma,but the mortality rate remains high.There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries.The purpose of this study was to summarize the experience of the treatment of pancreatic injury in this center,and to explore the risk factors for re-laparotomy of pancreatic injury and clinical prognosis.Methods:Part 1:Ninety-five patients pancreatic trauma consectively at the Nanjing General Hospital of Nanjing Military Command from January 2007 to December 2016 were reviewed retrospectively.Part 2:Ninety-five patients who underwent surgical treatment with pancreatic trauma consectively at the Nanjing General Hospital of Nanjing Military Command from January 2007 to December 2016 were reviewed retrospectively.The factors related to re-laparotomy after pancreatic trauma were analyzed by univariate and multivariate Logistic regression model.Part 3:Ninety-five patients who underwent surgical treatment with pancreatic trauma consectively at the Nanjing General Hospital of Nanjing Military Command from January 2007 to December 2016 were reviewed retrospectively.The factors related to survival rate of pancreatic trauma were analyzed by univariate and multivariate Logistic regression model.Results:Part 1:A toal 95 cases with pancreatic trauma were included in the study.There were 57 cases of mild pancreatic trauma(AAST ?,? grade)and 38 cases of severe pancreatic trauma(AAST III,IV,V grade).Surgical treatment of 95 cases,simple suture drainage of 63 cases,distal pancreatectomy in 6 cases,pancreatoduodenectomy or distal pancreaticojejunostomy in 4 cases,the other 22 patients underwent controlled surgery.The overall mortality was 13.7%(13/95),of which 1 died of severe cerebral trauma coma,5 died of pancreatic fluid erosion caused by peritoneal active bleeding,7 died of severe pancreatic necrosis,pancreatic fistula and infection caused by multiple organ failure.95 cases were cured,including 26 cases of pancreatic fistula,30 cases of abdominal abscess,30 cases of abdominal bleeding,24 cases of sepsis,multiple organ failure in 12 cases.Part 2:A total of 95 cases of pancreatic trauma postoperative,59 patients received only one laparotomy surgery and 36 cases need to re-laparotomy surgery.Univariate analysis filtered 19 potential risk factors,and Logistic regression analysis revealed that significant risk factors of re-laparotomy after pancreatic trauma were ISS(P=0.037),whether the outer hospital surgery(P=0.040),postoperative day 6 hemoglobin(P=0.025),postoperative day 6 albumin(P=0.013),postoperative day 6 calcitonin(P=0.023)and fresh frozen plasma transfused(P=0.041).Using ROC analysis,postoperative day 6 calcitonin had a better discriminative power for re-laparotomy after pancreatic trauma(AUC 0.865)than ISS,fresh frozen plasma transfused(AUC 0.810,0.643,respectively).Part 3:A total of 95 cases of pancreatic trauma after surgery,the overall mortality rate was 13.7%.Result of univariate analysis indicated that age,hemodynamic status,ISS,postoperative CRP,postoperative calcitonin,postoperative albumin,postoperative creatinine and intraoperative blood transfusion were significant factors that influence the incidence rate of pancreatic trauma mortality(P<0.05).Logistic regression analysis revealed that the independent risk factors of prognosis of pancreatic trauma after surgery were age(P= 0.017),preoperative hemodynamic instability(P = 0.022),postoperative CRP? 154mg/L(P = 0.028),and postoperative creatinine ? 177 ? mol/L(P = 0.018).Conclusion:(1)Damage control surgery can reduce the mortality of pancreatic injury,severe intra-abdominal infection and pancreatic juice lead to peritoneal hemorrhage is the main reason for clinical prognosis.(2)The important factor for re-laparotomy after pancreatic trauma is the irrationality of surgery and inadequate drainage.ISS,postoperative day 6 calcitonin and fresh frozen plasma transfusedwere independent risk factors for re-laparotomy after pancreatic trauma.(3)Preoperative hemodynamic instability,postoperative severe inflammatory response(CRP?154mg/L),postoperative renal insufficiency(creatinine? 177 ?mol/L)and the older age indicates a higher incidence of death.(4)The timely treatment of pancreatic injury,the scientific treatment of complications are the key to the prognosis.Damage control surgery,nutritional support theory,intestinal barrier dysfunction,and control of abdominal infection sources are the theoretical basis for the treatment of pancreatic injury.