ObjectiveTo summarize the clinical characteristics of traumatic pancreatitis (TP) after pancreatic trauma and illustrate the experience of specialized treatment. MethodsClinical data of 73 patients with TP treated in our hospital from January 2008 to June 2014 were collected. The pancreatic injury location, grade, and TP pathogenic factors were analyzed, summarized the common problem and the regularity in TP course, and summarized the treatment strategy, methods of surgical intervention, operation key points and difficulties of TP. ResultsThe grade of pancreatic trauma in the all of patients was mainly to levels of 2, 3, and 4, the head of the pancreas injury accounted for 31.5% (23/73), cervical pancreatic body and tail injuries accounted for 68.5% (50/73). Fifty-nine patients were from other hospitals referral. The occurrence of TP peak period was 4-7 days after pancreatic trauma. Pancreatic fistula and uncontrolled peritoneal infection were the treatment difficulty of TP. It's the effective minimally invasive treatment methods for TP that percutaneous catheter drainage, pancreatic duct stent placement, and endoscopic abscess debridement. Forty-two patients with TP needed reoperations, and 19 cases underwent more than 2 times operation. ConclusionsBecause of the condition of TP is complex and changeable, and difficulty to treat, so the early definitive diagnosis and appropriate surgical strategy play a crucial role in the treatment of TP. Besides, professional team of pancreatic surgery has advantages in estimating patients' conditions, selecting and performing surgical interventions.
ObjectiveTo investigate diagnosis and treatment of rupture of pancreatic cystic disease. MethodThe clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively. Results① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken. ConclusionsHow to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.
Objective To compare the surgical outcome of surgical treatment for chronic pancreatic head mass pancreatitis combined with pancreatic duct stones. Methods Clinical data of 19 patients diagnosed as chronic pancreatic head mass pancreatitis combined with pancreatic duct stones by pathology in our hospital were analyzed retrospectively and patients were divided into Beger group (n=9) and Frey group (n=10) according to operation type. Results The duration of operation, blood loss, morbidity, ratio of postoperative pancreatic fistula of grade B, ratio of abdominal cavity infection, ratio of gastric emptying dysfunction, total length of hospital stay, and total hospitalization cost in Frey group were less or lower than those in Beger group significantly (P ＜0.05). None of death or pancreatic fistula of grade C happened in both 2 groups, and abdominal pain and jaundice were subsided in all patients. There were 18 patients (94.7%) were followed up for (8.6±2.5) years ( 5-12 years), and just 1 patient of Frey group was not available for followup. The ratios of 5-year pain subsided of 2 groups were both 7/9, there was no significant difference between the 2 groups (P>0.05). During the follow-up period, there was no dead, relapsed, cancerate or reoperation, but 2 patients suffered from diabetes (1 patient of Frey group and 1 patient of Beger group), 2 patients suffered from steatorrhea (1 patient of Frey group and 1 patient of Beger group), and there was no significant difference between the 2 groups in the ratios of diabetes and steatorrhea (P>0.05). Conclusion The effect is equal for Frey surgery and Beger surgery in treatment of chronic pancreatic head mass pancreatitis combined with pancreatic duct stones, but recover of patient who receives Frey surgery is better than that of Beger surgery.