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Objective To explore the methods for early diagnosis and treatment of blunt pancreatic injury.Methods The clinical data of 32 patients with blunt pancreatic injury treated in our hospital from Janurery 2004 to Janurery 2009 were retrospectively analyzed.Results The conformity diagnosis rate of CT was 79.3%.Four cases received nonoperative treatment including 3 cases of grade I and 1 of grade II injury.A total of 28 cases with blunt pancreatic injury underwent operation: 5 grade I and 7 grade II cases underwent debridement and drainage;among the patients with grade Ⅲ injury,4 underwent distal pancreatectomy in combination with splenectomy,and 2 pancreatectomy with spleen preservation;amongst the 5 patients with grade Ⅳ injury,4 underwent Roux-en-Y pancreaticojejunostomy and 1 underwent distal pancreatectomy in combination with splenectomy;of the 5 patients with grade Ⅴ injury,1 case was operated on using duodenorrhaphy and diverticulization,2 underwent the Whipple′s procedare and 2 had damage control surgery.Three patients died of multiple organ failure,and complications occurred in 19(76.0%).Pancreatic fistula and pancreatic pseudocysts were the main complications.Conclusions In the absence of major pancreatic ductal injury,and the clinical conditions were stable,pancreatic injuries can be treated with nonoperative management.Operative treatment is suitable for severe blunt pancreatic injury.Appropriate operation,based on patient condition and the classification of pancrecatic trauma,is the key to increase the cure rate and decrease mortality rate.
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Objective To explore the diagnosis and treatment of liver trauma.Methods A retrospectively analysis of clinical data of 160 cases of liver trauma, including 96 cases of blunt trauma and 64 cases of open trauma, was made.Results Among the 160 cases, one case with stage IV trauma and severe thoracic injury died 30min after admission. Among the other 159 cases, 45cases (9 cases of stage Ⅰ, 31 cases of stage Ⅱ and 5cases of cases Ⅲ) received nonoperative treatment, and 114cases (7 cases of stage Ⅱ, 67 cases of stage Ⅲ and 50 cases of stage Ⅳ) received operative therapy. In non-operative treatment group, the cure rate was 100 %(45/45). In operation treatment group the cure rate was 98.2 %(112/114), the mortality rate was 1.8 %(2/114), 1 case died of hemorrhage after operation and 1 case died of ARDS. Five patients with postoperative complications were cured, including hepatic abscess in 2 cases, biliary fistula in 2 cases, and hemorrhage after operation in 1 case. Conclusions B-ultrasound is the method of choice for diagnosis of liver trauma, and CT can be used if conditions permit. Cases of lives truma of stages Ⅰ and Ⅱ and some cases of stage Ⅲ that have stable hemodynamics, can receive nonoperative treatment under close observation. Some cases of stage Ⅱ, most cases of stage Ⅲ and all cases of stages Ⅳ to Ⅵ injury should preferably undergo surgical treatment.
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Objective To explore the feasibility and indications of non-operative management for blunt liver injury.Methods The clinical data of 109 patients with blunt liver injury treated in recent 5 years were reviewed retrospectively.Results Among 109 cases, 35 were treated with nonoperation and 33(94.3 %) were cured; there were 3 cases(9.1 %) with complications among the 33 cases who were cured. The mean amount of blood transfusion, hospitalization days and expenses were (2.5?0.8)U,(13.2?1.3)d and (5 250?335) yuan, respectively. Seventy-four cases were treated with operation and 68(91.2 %)were cured, there were 14 cases (20.6 %) with complications among the 68 cases who were cured. The mean amount of blood transfusion,number of hospitalization days and expenses were (8.4?1.1)U,(15.4?0.9)d and (13 550?805) yuan,respectively.The mean amount of blood transfusion and hospitalization expenses of nonoperative group were lower than those of operative group (P
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Objective To investigate the clinical significance and indications of non operative management for liver trauma(LT). Methods The clinical date of 66 cases of LT treated by non operation from November 1987 to November 2000 were retrospectively analyzed. Results There were 38 cases (57.6%) in class I of LT, 18(27.3%) in class II, 10(15.2%) in class III in this series. 64 cases were cured (97.0%), including 2 cases combined with active bleeding were converted to operation and curred; 2 cases (3.0%) died of combining with severe brain damag. 4 cases(6.1%) complicated with liver abscess were cured by non operative treatment. Conclusions The non operative management is suitable for all cases of class I, II and partial cases of class III of LT. The observation of blood dynamics is most important, and B-type ultrasonography is also imporant, The operation would be done if the case is combined with massive active bleeding.