Diagnosis and treatment of pancreatic injury: a single center experience on 55 patients / 中华肝胆外科杂志

ABSTRACT

Objective:To review experience on the diagnosis and treatment of patients with pancreatic injury.Methods:There were 65 patients with pancreatic injuries who were managed in the First Affiliated Hospital of Xi’an Jiaotong University between January 1995 and December 2017. After excluding 6 patients with inadequate data and 4 patients with other associated injuries, the remaining 55 patients were enrolled in this retrospective study. All data, including the type of abdominal trauma, general information of patients, clinical manifestations, methods of diagnosis, treatment, operation and complication were collected and analysed. Analyze the cause, degree of injury, treatment measures, treatment results and complications of patients with pancreatic injury.Results:The most common cause of pancreatic injury was traffic accidents (23 patients, 41.8%), with a correct preoperative diagnostic rate of 61.8% for pancreatic injury. Compute tomography (CT) had a significantly higher sensitivity than sonography (80% vs. 37.5%, P<0.05). The number of patients with grade I-V pancreatic injury were 7, 19, 24, 1 and 4, respectively. Sixteen patients were successfully managed by conservative treatment, and 39 patients underwent various surgeries depending on the injury grade. Significantly more patients having severe grades (III-V) underwent surgical treatment than those having mild grades (I-II) (53.8% vs. 86.2%, P<0.05). Two patients died after surgery (mortality rate 5.1%, 2/39). Pancreatic fistula developed in 29 patients (74.4%), intra-abdominal infection in 10 patients (25.6%) and these were the main surgical complications. Patients having severe grades had a significantly higher pancreatic fistula rate than those having mild grades. Pancreatic pseudocyst was the most common complication on long-term follow-up (8 patients, 14.5%). This complication was significantly higher in patients who were managed with consecutive treatment than with operation (31.2% vs. 7.7%, P<0.05). Conclusions:The preoperative diagnosis of pancreatic injury was difficult, and CT should be the first line investigation. Grade I -II injuries could be managed by conservative treatment, while grade III-V should be treated by operations. The most common short- and long-term complications of pancreatic injury were pancreatic fistula and pancreatic pseudocyst, respectively.