Surgical management of pancreatic trauma.
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概要
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From 1978 to 1990, fifty patients were operated on for pancreatic trauma at the National Mito Hospital Emergency Center. The injury classification we favor is described. Three types ( I, II, III) of injury were classified in view of the presence of absence of major pancreatic duct and combined duodenal injury. Types II and III were further classified into two subtypes (IIa, IIb and IIIa, IIIb) based on the point of peripancreatic devascularization. This classification system is simple and determines the operative treatment. Type I is best treated by simple repair and drainage, Type II by distal pancreatectomy, and Type III by duodenal repair or resection in addition to treatment of the pancreas. This system represents prognosis based on mortality rate. Simple repair and drainage were performed in 30 patients (60%), distal pancreatectomy in 11 (22%), the Letton-Wilson method in 1 (2%), head partial resection in 1 (2%), pancreaticoduodenectomy in 1 (2%), and Roux-en-Y duodenal jejunostomy in 7 (14%). In pancreatic trauma we have preferred distal pancreatectomy to the reconstructive procedure for the safety of operation. Even so there is slight possibility that distal pancreatectomy may eliminate pacreatic function. Thus there has been a tendency toward more frequent use of distal pancreatectomy (22%). Eleven patients treated by under 80% distal pancreatectomy were well managed, since only one patient developed postoperative diabetes and no exocrine pancreatic insufficiency was found. The postoperative morbidity rate (36%) after distal pancreatectomy was almost equal to that of simple repair and drainage. We recommend distal pancreatectomy as the standard procedure, since it is simple, safe, and the risk of endocrine or exocrine pancreatic insufficiency afterward is very small. The overall mortality rate was 16%, and the postoperative morbidity was 42%. Our experience suggests that postoperative morbidity and mortality after pancreatic trauma are minimized by early control of massive hemorrhaging from major peripancreatic vessels and by taking reasonable procedural measures based on recognition of the injury type.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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