Surgical diagnosis and management of 15 patients with blunt pancreatic trauma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TAN Yong , WU Liming , ZHU Jianhua , LIU Wenying , OUYANG Zaixing , SONG Hao ,  HUANG Congyun

Department of Hepatobiliary Surgery, Yuebei People’s Hospital, Shantou University Medical College, Shaoguan, Guangdong 512025, P. R. China;

Corresponding author：

HUANG Congyun, Email: 302906581@qq.com

Keywords：

pancreatic trauma; diagnosis; surgical treatment; complication

DOI：

10.7507/1007-9424.202202003

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the experience of surgical diagnosis and management of patients with blunt pancreatic trauma. Methods The clinical data of 15 patients with blunt pancreatic trauma who underwent surgical treatment in the Yuebei People’s Hospital from January 2019 to April 2021 were retrospectively collected. The injury causes, early diagnostic methods, surgical treatment results, and major complications of patients with blunt pancreatic trauma were analyzed. Results The causes of blunt pancreatic trauma: traffic accident injury (seven patients), falling injury (four patients), impact injury (three patients), and crush injury (one patient). Organ Injury Scale grading system of the American Association for the Surgery of Trauma grading of pancreatic trauma: grade Ⅱ (five patients), grade Ⅲ (seven patients), grade Ⅳ (two patients), and grade Ⅴ (one patient). The patients whose serum amylase value was more than four times of reference value (104 U/L) or who underwent enhanced CT were diagnosed with pancreatic trauma before operation. Two patients underwent pancreatoduodenectomy, two patients underwent removal of peripancreatic hematoma+pancreaticojejunostomy, seven patients underwent distal pancreatectomy, two patients underwent suture hemostasis of pancreas, two patients underwent clearance and drainage of pancreatic necrosis. One patient died of combined injury and bleeding. Major complications: five patients suffered from biochemical leakage, three patients suffered from grade B and one patient suffered from grade C pancreatic fistula, one patient suffered from abdominal pseudoaneurysm and hemorrhage. Conclusions The early diagnosis and grading of pancreatic injury should be combined with the history of injury, serum amylase level, and abdominal enhanced CT. Surgical intervention should be carried out as early as possible for high-grade pancreatic trauma.

Citation： TAN Yong, WU Liming, ZHU Jianhua, LIU Wenying, OUYANG Zaixing, SONG Hao, HUANG Congyun. Surgical diagnosis and management of 15 patients with blunt pancreatic trauma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1350-1354. doi: 10.7507/1007-9424.202202003 Copy

1.	Ayoob AR, Lee JT, Herr K, et al. Pancreatic trauma: imaging review and management update. Radiographics, 2021, 41(1): 58-74.
2.	Girard E, Abba J, Arvieux C, et al. Management of pancreatic trauma. J Visc Surg, 2016, 153(4): 259-268.
3.	丁威威, 王凯, 刘宝晨, 等. 胰腺外伤单中心136例诊治报告. 中国实用外科杂志, 2018, 38(7): 782-785.
4.	白雪巍, 陈华, 刘杰, 等. 危重胰腺外伤专科化治疗8例疗效分析. 中国实用外科杂志, 2015, 35(3): 302-307.
5.	杨文博, 李乐, 陈华, 等. 闭合性胰腺损伤的临床诊治分析. 中华外科杂志, 2019, 57(9): 660-665.
6.	Kuza CM, Hirji SA, Englum BR, et al. Pancreatic injuries in abdominal trauma in US adults: analysis of the National Trauma Data Bank on management, outcomes, and predictors of mortality. Scand J Surg, 2020, 109(3): 193-204.
7.	Zeidenberg J, Durso AM, Caban K, et al. Imaging of penetrating torso trauma. Semin Roentgenol, 2016, 51(3): 239-255.
8.	陈庆永, 王春友, 蒋春舫, 等. 钝性胰腺损伤合并主胰管损伤的诊断和治疗（附35例报告）. 第四届全国灾害医学学术会议论文集. 上海: 中国中西医结合学会, 2007: 170-172.
9.	刘志伟, 蔡守旺, 何蕾, 等. 创伤性胰腺损伤诊断治疗的临床分析. 中华肝胆外科杂志, 2012, 18(9): 676-679.
10.	赵铭宁, 吴文广, 陶怡菁, 等. 内镜逆行胰胆管造影在闭合性胰腺损伤诊疗中的应用(附10例报告). 中国实用外科杂志, 2014, 34(6): 552-555.
11.	Daly KP, Ho CP, Persson DL, et al. Traumatic retroperitoneal injuries: review of multidetector CT findings. Radiographics, 2008, 28(6): 1571-1590.
12.	廖茜, 何文华, 余晨, 等. 外伤性胰腺炎的CT表现及预后评估. 实用放射学杂志, 2021, 37(2): 243-247.
13.	刘川, 金平, 屠旭旦, 等. 非手术治疗Ⅳ级胰腺损伤二例. 中华创伤杂志, 2017, 33(11): 1038-1040.
14.	Sutherland I, Ledder O, Crameri J, et al. Pancreatic trauma in children. Pediatr Surg Int, 2010, 26(12): 1201-1206.
15.	薛建锋, 郝乔, 程波, 等. 3级胰腺损伤13例诊治分析. 中华急诊医学杂志, 2019, 28(9): 1139-1141.
16.	Hasanovic J, Agic M, Rifatbegovic Z, et al. Pancreatic injury in blunt abdominal trauma. Med Arch, 2015, 69(2): 130-132.
17.	Menahem B, Lim C, Lahat E, et al. Conservative and surgical management of pancreatic trauma in adult patients. Hepatobiliary Surg Nutr, 2016, 5(6): 470-477.
18.	任华建, 王革非, 顾国胜, 等. 腹部创伤后急诊胰十二指肠切除手术的预后分析. 创伤外科杂志, 2017, 19(12): 892-896.
19.	Krige JE, Kotze UK, Setshedi M, et al. Prognostic factors, morbidity and mortality in pancreatic trauma: a critical appraisal of 432 consecutive patients treated at a Level 1 Trauma Centre. Injury, 2015, 46(5): 830-836.
20.	李宇, 丁泓帆, 刘学民, 等. 单中心55例胰腺损伤诊治方法及效果. 中华肝胆外科杂志, 2020, 26(8): 615-619.

1. Ayoob AR, Lee JT, Herr K, et al. Pancreatic trauma: imaging review and management update. Radiographics, 2021, 41(1): 58-74.
2. Girard E, Abba J, Arvieux C, et al. Management of pancreatic trauma. J Visc Surg, 2016, 153(4): 259-268.
3. 丁威威, 王凯, 刘宝晨, 等. 胰腺外伤单中心136例诊治报告. 中国实用外科杂志, 2018, 38(7): 782-785.
4. 白雪巍, 陈华, 刘杰, 等. 危重胰腺外伤专科化治疗8例疗效分析. 中国实用外科杂志, 2015, 35(3): 302-307.
5. 杨文博, 李乐, 陈华, 等. 闭合性胰腺损伤的临床诊治分析. 中华外科杂志, 2019, 57(9): 660-665.
6. Kuza CM, Hirji SA, Englum BR, et al. Pancreatic injuries in abdominal trauma in US adults: analysis of the National Trauma Data Bank on management, outcomes, and predictors of mortality. Scand J Surg, 2020, 109(3): 193-204.
7. Zeidenberg J, Durso AM, Caban K, et al. Imaging of penetrating torso trauma. Semin Roentgenol, 2016, 51(3): 239-255.
8. 陈庆永, 王春友, 蒋春舫, 等. 钝性胰腺损伤合并主胰管损伤的诊断和治疗（附35例报告）. 第四届全国灾害医学学术会议论文集. 上海: 中国中西医结合学会, 2007: 170-172.
9. 刘志伟, 蔡守旺, 何蕾, 等. 创伤性胰腺损伤诊断治疗的临床分析. 中华肝胆外科杂志, 2012, 18(9): 676-679.
10. 赵铭宁, 吴文广, 陶怡菁, 等. 内镜逆行胰胆管造影在闭合性胰腺损伤诊疗中的应用(附10例报告). 中国实用外科杂志, 2014, 34(6): 552-555.
11. Daly KP, Ho CP, Persson DL, et al. Traumatic retroperitoneal injuries: review of multidetector CT findings. Radiographics, 2008, 28(6): 1571-1590.
12. 廖茜, 何文华, 余晨, 等. 外伤性胰腺炎的CT表现及预后评估. 实用放射学杂志, 2021, 37(2): 243-247.
13. 刘川, 金平, 屠旭旦, 等. 非手术治疗Ⅳ级胰腺损伤二例. 中华创伤杂志, 2017, 33(11): 1038-1040.
14. Sutherland I, Ledder O, Crameri J, et al. Pancreatic trauma in children. Pediatr Surg Int, 2010, 26(12): 1201-1206.
15. 薛建锋, 郝乔, 程波, 等. 3级胰腺损伤13例诊治分析. 中华急诊医学杂志, 2019, 28(9): 1139-1141.
16. Hasanovic J, Agic M, Rifatbegovic Z, et al. Pancreatic injury in blunt abdominal trauma. Med Arch, 2015, 69(2): 130-132.
17. Menahem B, Lim C, Lahat E, et al. Conservative and surgical management of pancreatic trauma in adult patients. Hepatobiliary Surg Nutr, 2016, 5(6): 470-477.
18. 任华建, 王革非, 顾国胜, 等. 腹部创伤后急诊胰十二指肠切除手术的预后分析. 创伤外科杂志, 2017, 19(12): 892-896.
19. Krige JE, Kotze UK, Setshedi M, et al. Prognostic factors, morbidity and mortality in pancreatic trauma: a critical appraisal of 432 consecutive patients treated at a Level 1 Trauma Centre. Injury, 2015, 46(5): 830-836.
20. 李宇, 丁泓帆, 刘学民, 等. 单中心55例胰腺损伤诊治方法及效果. 中华肝胆外科杂志, 2020, 26(8): 615-619.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical diagnosis and management of 15 patients with blunt pancreatic trauma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content