The Experience of Specialized Treatment of 73 Cases of Traumatic Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 BAIXue-wei , DINGYi-xuan , CHENHua , LIUJie , WULin-feng , JIANGHong-chi ,  SUNBei

Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China;

Corresponding author：

SUNBei, Email: sunbei70@tom.com

Keywords：

Pancreatic trauma; Traumatic pancreatitis; Pancreatic fistula; Diagnosis; Treatment

DOI：

10.7507/1007-9424.20150004

Video：

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Objective To summarize the clinical characteristics of traumatic pancreatitis (TP) after pancreatic trauma and illustrate the experience of specialized treatment. Methods Clinical 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. Results The 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. Conclusions Because 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.

Citation： BAIXue-wei, DINGYi-xuan, CHENHua, LIUJie, WULin-feng, JIANGHong-chi, SUNBei. The Experience of Specialized Treatment of 73 Cases of Traumatic Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(1): 11-17. doi: 10.7507/1007-9424.20150004 Copy

1.	Uma Debi, Ravinder Kaur, Kaushal Kishor Prasad, et al. Pancreatic trauma:A concise review. World J Gastroenterol, 2013, 19(47):9003-9011.
2.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
3.	Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scalingⅡ:pancreas, duodenum, small bowel, colon and rectum. J Trauma, 1990, 30(11):1427-1429.
4.	Kao LS, Bulger EM, Parks DL, et al. Predictors of morbidity after traumatic pancreatic injury. J Trauma, 2003, 55(5):898-905.
5.	Cirillo RL Jr, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg, 2002, 6(4):587-598.
6.	Adamson WT, Hebra A, Thomas PB, et al. Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma. J Pediatr Surg, 2003, 38(3):354-357.
7.	Gomez MA, Besson M, Scotto B, et al. MR imaging in the evaluation of blunt pancreatic Trauma. J Radiol, 2004, 85(4 Pt 1):414-417.
8.	白雪巍, 姜脉涛, 姜洪池, 等.多学科协作及创伤递升式治疗重症急性胰腺炎1例.中国实用外科杂志, 2014, 34(6):577-580.
9.	姜洪池, 孙备, 陆朝阳.重症急性胰腺炎基本治疗原则初探.中华外科杂志, 2007, 45(1):6-8.
10.	童智慧, 李维勤, 虞文魁, 等.不同营养支持模式对重症急性胰腺炎病人治疗效果的影响.肠外与肠内营养, 2009, 16(2):65-68.
11.	张健, 谷佃宝, 桑节峰, 等.超声引导经皮穿刺置管引流术在重症急性胰腺炎中的应用(附35例报道).中国普外基础与临床杂志, 2011, 18(10):1107-1108.
12.	Sathyanarayan G, Garg PK, Prasad H, et al. Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis. J Gastroenterol Hepatol, 2007, 22(4):550-554.
13.	姚欣敏, 李云涛, 黄德全, 等.多种微创方法联合个体化治疗重症急性胰腺炎.中国普外基础与临床杂志, 2010, 17(6):586-590.
14.	Kim HS, Lee DK, Kim IW, et al. The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc, 2001, 54(1):49-55.
15.	Malgras B, Douard R, Siauve N, et al. Management of left pancreatic trauma. Am Surg, 2011, 77(1):1-9.
16.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acutepancreatitis-2012:revision of the Atlanta classification and definitionsby international consensus. Gut, 2013, 62(1):102-111.
17.	Kouraklis G, Spirakos S, Glinavou A. Damage control surgery:analternative approachfor the management of critically injured patients. Surg Today, 2002, 32(3):195-202.
18.	李乐, 孙备.损伤控制性外科理念在胰腺外科中应用现状.中国实用外科杂志, 2013, 33(6):519-521.
19.	van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-upapproach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16):1491-1502.
20.	孙备, 宋增福, 姜洪池, 等.创伤递升式分阶段处理重症急性胰腺炎.中华外科杂志, 2013, 51(6):493-498.
21.	Lerch MM, Stier A, Wahnschaffe U, et al. Pancreatic pseudocysts:observation, endoscopic drainage, or resection? Dtsch Arztebl Int, 2009, 106(38):614-621.
22.	Aldridge MC, Francis ND, Glazer G, et al. Colonic complication of severe acute pancreatitis. Br J Surg, 1989, 76(4):362-367.
23.	Correa-Gallego C, Brennan MF, D'Angelica MI, et al. Contemporary experience with postpancreatectomy hemorrhage:results of 1 122 patients resected between 2006 and 2011. J Am Coll Surg, 2012, 215 (5):616-621.
24.	Roulin D, Cerantola Y, Demartines N, et al. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg, 2011, 15(6):1055-1062.
25.	Sanjay P, Fawzi A, Fulke JL, et al. Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP, 2010, 11(3):220-225.

1. Uma Debi, Ravinder Kaur, Kaushal Kishor Prasad, et al. Pancreatic trauma:A concise review. World J Gastroenterol, 2013, 19(47):9003-9011.
2. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
3. Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scalingⅡ:pancreas, duodenum, small bowel, colon and rectum. J Trauma, 1990, 30(11):1427-1429.
4. Kao LS, Bulger EM, Parks DL, et al. Predictors of morbidity after traumatic pancreatic injury. J Trauma, 2003, 55(5):898-905.
5. Cirillo RL Jr, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg, 2002, 6(4):587-598.
6. Adamson WT, Hebra A, Thomas PB, et al. Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma. J Pediatr Surg, 2003, 38(3):354-357.
7. Gomez MA, Besson M, Scotto B, et al. MR imaging in the evaluation of blunt pancreatic Trauma. J Radiol, 2004, 85(4 Pt 1):414-417.
8. 白雪巍, 姜脉涛, 姜洪池, 等.多学科协作及创伤递升式治疗重症急性胰腺炎1例.中国实用外科杂志, 2014, 34(6):577-580.
9. 姜洪池, 孙备, 陆朝阳.重症急性胰腺炎基本治疗原则初探.中华外科杂志, 2007, 45(1):6-8.
10. 童智慧, 李维勤, 虞文魁, 等.不同营养支持模式对重症急性胰腺炎病人治疗效果的影响.肠外与肠内营养, 2009, 16(2):65-68.
11. 张健, 谷佃宝, 桑节峰, 等.超声引导经皮穿刺置管引流术在重症急性胰腺炎中的应用(附35例报道).中国普外基础与临床杂志, 2011, 18(10):1107-1108.
12. Sathyanarayan G, Garg PK, Prasad H, et al. Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis. J Gastroenterol Hepatol, 2007, 22(4):550-554.
13. 姚欣敏, 李云涛, 黄德全, 等.多种微创方法联合个体化治疗重症急性胰腺炎.中国普外基础与临床杂志, 2010, 17(6):586-590.
14. Kim HS, Lee DK, Kim IW, et al. The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc, 2001, 54(1):49-55.
15. Malgras B, Douard R, Siauve N, et al. Management of left pancreatic trauma. Am Surg, 2011, 77(1):1-9.
16. Banks PA, Bollen TL, Dervenis C, et al. Classification of acutepancreatitis-2012:revision of the Atlanta classification and definitionsby international consensus. Gut, 2013, 62(1):102-111.
17. Kouraklis G, Spirakos S, Glinavou A. Damage control surgery:analternative approachfor the management of critically injured patients. Surg Today, 2002, 32(3):195-202.
18. 李乐, 孙备.损伤控制性外科理念在胰腺外科中应用现状.中国实用外科杂志, 2013, 33(6):519-521.
19. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-upapproach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16):1491-1502.
20. 孙备, 宋增福, 姜洪池, 等.创伤递升式分阶段处理重症急性胰腺炎.中华外科杂志, 2013, 51(6):493-498.
21. Lerch MM, Stier A, Wahnschaffe U, et al. Pancreatic pseudocysts:observation, endoscopic drainage, or resection? Dtsch Arztebl Int, 2009, 106(38):614-621.
22. Aldridge MC, Francis ND, Glazer G, et al. Colonic complication of severe acute pancreatitis. Br J Surg, 1989, 76(4):362-367.
23. Correa-Gallego C, Brennan MF, D'Angelica MI, et al. Contemporary experience with postpancreatectomy hemorrhage:results of 1 122 patients resected between 2006 and 2011. J Am Coll Surg, 2012, 215 (5):616-621.
24. Roulin D, Cerantola Y, Demartines N, et al. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg, 2011, 15(6):1055-1062.
25. Sanjay P, Fawzi A, Fulke JL, et al. Late post pancreatectomy haemorrhage. Risk factors and modern management. JOP, 2010, 11(3):220-225.

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The Experience of Specialized Treatment of 73 Cases of Traumatic Pancreatitis

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