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：

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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, 王凱, 劉寶晨, 等. 胰腺外傷單中心136例診治報告. 中國實用外科雜志, 2018, 38(7): 782-785.
4.	白雪巍, 陳華, 劉杰, 等. 危重胰腺外傷專科化治療8例療效分析. 中國實用外科雜志, 2015, 35(3): 302-307.
5.	楊文博, 李樂, 陳華, 等. 閉合性胰腺損傷的臨床診治分析. 中華外科雜志, 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.	陳慶永, 王春友, 蔣春舫, 等. 鈍性胰腺損傷合并主胰管損傷的診斷和治療（附35例報告）. 第四屆全國災害醫學學術會議論文集. 上海: 中國中西醫結合學會, 2007: 170-172.
9.	劉志偉, 蔡守旺, 何蕾, 等. 創傷性胰腺損傷診斷治療的臨床分析. 中華肝膽外科雜志, 2012, 18(9): 676-679.
10.	趙銘寧, 吳文廣, 陶怡菁, 等. 內鏡逆行胰膽管造影在閉合性胰腺損傷診療中的應用(附10例報告). 中國實用外科雜志, 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, 何文華, 余晨, 等. 外傷性胰腺炎的CT表現及預后評估. 實用放射學雜志, 2021, 37(2): 243-247.
13.	劉川, 金平, 屠旭旦, 等. 非手術治療Ⅳ級胰腺損傷二例. 中華創傷雜志, 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.	薛建鋒, 郝喬, 程波, 等. 3級胰腺損傷13例診治分析. 中華急診醫學雜志, 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.	任華建, 王革非, 顧國勝, 等. 腹部創傷后急診胰十二指腸切除手術的預后分析. 創傷外科雜志, 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, 劉學民, 等. 單中心55例胰腺損傷診治方法及效果. 中華肝膽外科雜志, 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, 王凱, 劉寶晨, 等. 胰腺外傷單中心136例診治報告. 中國實用外科雜志, 2018, 38(7): 782-785.
4. 白雪巍, 陳華, 劉杰, 等. 危重胰腺外傷專科化治療8例療效分析. 中國實用外科雜志, 2015, 35(3): 302-307.
5. 楊文博, 李樂, 陳華, 等. 閉合性胰腺損傷的臨床診治分析. 中華外科雜志, 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. 陳慶永, 王春友, 蔣春舫, 等. 鈍性胰腺損傷合并主胰管損傷的診斷和治療（附35例報告）. 第四屆全國災害醫學學術會議論文集. 上海: 中國中西醫結合學會, 2007: 170-172.
9. 劉志偉, 蔡守旺, 何蕾, 等. 創傷性胰腺損傷診斷治療的臨床分析. 中華肝膽外科雜志, 2012, 18(9): 676-679.
10. 趙銘寧, 吳文廣, 陶怡菁, 等. 內鏡逆行胰膽管造影在閉合性胰腺損傷診療中的應用(附10例報告). 中國實用外科雜志, 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, 何文華, 余晨, 等. 外傷性胰腺炎的CT表現及預后評估. 實用放射學雜志, 2021, 37(2): 243-247.
13. 劉川, 金平, 屠旭旦, 等. 非手術治療Ⅳ級胰腺損傷二例. 中華創傷雜志, 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. 薛建鋒, 郝喬, 程波, 等. 3級胰腺損傷13例診治分析. 中華急診醫學雜志, 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. 任華建, 王革非, 顧國勝, 等. 腹部創傷后急診胰十二指腸切除手術的預后分析. 創傷外科雜志, 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, 劉學民, 等. 單中心55例胰腺損傷診治方法及效果. 中華肝膽外科雜志, 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

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