Journal of Trauma and Injury

  • 제24권2호
  • /
  • Pages.68-74
  • /
  • 2011
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

개복 수술로 확인된 외상성 췌장 손상 환자에 대한 임상적 고찰

Clinical Analysis of Traumatic Pancreatic Injury

  • 황보선미 (경북대학교 의학전문대학원 외과학교실) ;
  • 권영봉 (경북대학교 의학전문대학원 외과학교실) ;
  • 윤경진 (경북대학교 의학전문대학원 외과학교실) ;
  • 권형준 (경북대학교 의학전문대학원 외과학교실) ;
  • 천재민 (경북대학교 의학전문대학원 외과학교실) ;
  • 김상걸 (경북대학교 의학전문대학원 외과학교실) ;
  • 박진영 (경북대학교 의학전문대학원 외과학교실) ;
  • 황윤진 (경북대학교 의학전문대학원 외과학교실) ;
  • 윤영국 (경북대학교 의학전문대학원 외과학교실)
  • HwangBo, Seon-Mi (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Kwon, Young-Bong (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Yun, Kyung-Jin (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Kwon, Hyung-Jun (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Chun, Jae-Min (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Kim, Sang-Geol (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Park, Jin-Young (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Hwang, Yun-Jin (Department of Surgery, School of Medicine, Kyungpook National University) ;
  • Yun, Young-Gook (Department of Surgery, School of Medicine, Kyungpook National University)
  • 투고 : 2011.10.06
  • 심사 : 2011.11.25
  • 발행 : 2011.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

키워드

참고문헌

  1. Beckingham IJ, Krige JE. ABC of diseases of liver, pancreas, and biliary system: liver and pancreatic trauma. Br Med J 2001;322:783-785. https://doi.org/10.1136/bmj.322.7289.783
  2. Berni GA, Bandyk DF, Oreskovich MR. Role of intraoperative pancreatography in patients with injury to the pancreas. Am J Surg 1982;143:602-605. https://doi.org/10.1016/0002-9610(82)90173-8
  3. Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL. Management of blunt major pancreatic injury. J Trauma 2004;56:774-778. https://doi.org/10.1097/01.TA.0000087644.90727.DF
  4. Olsen WR. The serum amylase in blunt abdominal trauma. J Trauma 1973;13:200-204. https://doi.org/10.1097/00005373-197303000-00003
  5. Jurkovich G, Bulger EM. Duodenum and pancreas. In: Mattox KL, Moore ME, Feleciano DV, editors. Trauma. New York: McGraw-Hill Companies, 2004:709-734.
  6. Boffard KD, Brooks AJ. Pancreatic trauma: injury to the pancreas and pancreatic duct. Eur J Surg 2000;166 :4-12. https://doi.org/10.1080/110241500750056454
  7. Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1976;183: 672-678. https://doi.org/10.1097/00000658-197606000-00009
  8. Jone RC. Management of pancreatic trauma. Am J Surg 1985;150:698-704. https://doi.org/10.1016/0002-9610(85)90412-X
  9. Farrell RJ, Krige JE, Bornman PC, Knottenbelt JD, Terblanche J. Operative strategies in pancreatic trauma. Br J Surg 1996;83:934-937. https://doi.org/10.1002/bjs.1800830715
  10. Krige JE. Pancreatic trauma. In: Nicol AJ, Steyn E, editors. Handbook of trauma. Cape Town: Oxford University Press;2004. p. 258-65.10. Bach RD, Frey CF. Diagnosis and treatment of pancreatic trauma. Am J Surg 1971;121:20-29. https://doi.org/10.1016/0002-9610(71)90073-0
  11. Choi W: Traumatic injury of the Pancreas. J Korean Soc Surg, 1978;20:997.
  12. Kim WP, Choi YB. Clinical review of traumatic pancreatic injuries. J Korean Surg Soc 1994;46:368-376.
  13. Chun SJ, Song OP, Cho MS, Clinical Analysis of the Traumatic Pancreatic Injuries. J Korean Soc Traumatol 1993;6:176-184.
  14. Lucas CE. Diagnosis and treatment of pancreatic and duodenal injury. Surg Clin North Am 1977;57:49-65. https://doi.org/10.1016/S0039-6109(16)41133-3
  15. Ryan S, Sandler A, Trenhaile S, Ephgrave K, Garner S. Pancreatic enzyme elevations after blunt trauma. Surgery 1994;116:622-627.
  16. Bach RD, Frey CF. Diagnosis and treatment of pancreatic trauma. Am J Surg 1971;121:20-29. https://doi.org/10.1016/0002-9610(71)90073-0
  17. Mullinix AJ, Foley WD. Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr 2004;28:20-27. https://doi.org/10.1097/01.rct.0000120858.80935.59
  18. Patton JH, Fabian Jr TC. Complex pancreatic injuries. Surg Clin North Am 1996;76:783-795. https://doi.org/10.1016/S0039-6109(05)70480-1
  19. Fulcher AS, Turner MA, Yelon JA, McClain LC, Broderick T, Ivatury RR, Sugerman HJ. Magnetic resonance cholangiopancreatography (MRCP) in the assessment of pancreatic duct trauma and its sequelae: preliminary findings. J Trauma 2000;48:1001-1007. https://doi.org/10.1097/00005373-200006000-00002
  20. Wales PW, Shuckett B, Kim PC. Long-term outcome after nonoperative management of complete traumatic pancreatic transaction in children. J Pediatr Surg 2001; 36:823-827. https://doi.org/10.1053/jpsu.2001.22970
  21. Feliciano DV. Abdominal Trauma. In: Schwart SI, Ellis H (eds). Maingot's Abdominal Operations. East Norwalk; Appleton & Lange, 1989:457-512.
  22. Subramanian A, Dente CJ, Feliciano DV. The management of pancreatictrauma in the modern era. Surg Clin North Am 2007;87:1515-1532. https://doi.org/10.1016/j.suc.2007.08.007
  23. Cushman JG, Feliciano DV, Renz BM, et al. Contemporary Management of Pancreatic Trauma, in Maull KI, Cleveland HC, Feliciano DV, et al (eds): Advances In Trauma and Criticl Care St. Louis, MO, Mosby, 1995;vol 10: 309-36.
  24. Walt AJ. Commentary, in Ivatury RR, Gayten GG (eds): Textbook of Penetrating Trauma. Baltimore, MD, Williams & Wilkins 1996;641-2.
  25. Lopez PP, Benjamin R, Cockburn M, et al. Recent trends in the management of combined pancreatoduodenal injuries. Am Surg 2005;71:847-852.