RESUMEN
Objective@#To summarize the experience of treatment for blunt pancreatic trauma.@*Methods@#The clinical data of 52 patients with blunt pancreatic trauma admitted to the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2018 were analyzed retrospectively.There were 40 male and 12 female patients, aging from 12 to 112 years with a median age of 35.5 years.According to the organ injury scale by American Association for the Surgery of Trauma(AAST) for pancreatic injury severity, 15 cases were in grade Ⅰ(28.8%), 20 cases were in grade Ⅱ(38.5%), 10 cases were in grade Ⅲ(19.2%),5 cases were in grade Ⅳ(9.6%) and 2 cases were in grade Ⅴ(3.8%). Isolated blunt pancreatic trauma occurred in 11(21.2%) patients including 5 cases of grade Ⅰ,5 cases of grade Ⅱ and 1 case of grade Ⅲ, and associated injuries existed in 41 patients(78.8%).@*Results@#Among 52 patients, 36 patients(69.2%) were transferred from other hospitals and 16(30.8%) patients were admitted through the emergency department. Finally, 49 patients(94.2%) were cured and 3 patients (5.8%) died.For the 15 cases of grade Ⅰ,9 patients were managed non-operatively, 5 cases underwent peritoneal lavage and drainage after surgery for the other injured abdominal organs, and 1 patient received percutaneous catheter drainage(PCD) with non-operative treatment. For the 20 cases of grade Ⅱ,4 cases only received non-operative treatment and 2 cases also received PCD. Besides, 2 cases underwent debridement and drainage for peripancreatic necrotic tissue and external drainage for pancreatic pseudocyst retrospectively after about 25 days of getting injured. As for patients who received exploratory laparotomy, 5 patients underwent suture repair associated with external drainage, and 7 patients were managed only with external drainage. For the 10 cases of grade Ⅲ,6 patients were cured through distal pancreatectomy and splenectomy with external drainage, while 2 patients underwent endoscopic retrograde cholangiopancreatography and ductal stenting, and the other 2 patients just received debridement and drainage for peripancreatic necrotic tissue.For the 5 cases of grade Ⅳ,2 patients underwent jejunostomy and abdominal cavity drainage, 1 patient had a pancreaticoduodenectomy with drainage,1 patient received suture repair of the pancreas and pancreaticojejunostomy, and 1 patient was managed with suture repair of the head of pancreas and external drainage.For the 2 patients of grade Ⅴ,1 patient received exploratory laparotomy and gauze compression packing hemostasis, and the other patient underwent pancreaticoduodenal repair, gastrointestinal anastomosis, duodenal exclusion surgery and external drainage.@*Conclusion@#According to the AAST classifications, associated injuries, physiological status and intraoperative situation, it could be better to make a comprehensive judgment, achieve early diagnosis and take appropriate individualized treatment strategy, and to improve the overall therapeutic effect for blunt pancreatic trauma.
RESUMEN
Objective To explore the use double butterfly wings raised platform method for patients with fixed effects of abdominal cavity drainage tube. Methods For the treatment of gynecological surgery in the hospital and abdominal cavity drainage tube of the clinical data of 245 patients were analyzed, and on October 31, 2016 as the cut-off time was divided into the control group of 119 cases and observation group of 126 cases in control group were treated by conventional methods for abdominal cavity drainage tube, observation group of patients with double butterfly wings raised platform in the abdominal cavity drainage tube was fixed, and comparative analysis of two groups patients with abdominal cavity drainage tube drainage effect, pull the pain caused by fixed effects, and the drainage tube. Results The observation group and the control group there was no statistically significant difference total indwelling time, pain score, to observe group posted time (2.00±1.36), respectively (3.00± 0.62), the control group, respectively (5.00 ± 1.89), (0.35 ± 0.05) points, two groups compare the difference was statistically significant (t=7.883,3.457, P<0.01), the observation group without pipe of 100.0％(126/126), the control group without pipe of 89.9％(107/119), part of the pipe of 7.6％(9/119), completely pipe of 2.5％ (3/119), two groups compare the difference was statistically significant (Z=-15.305, P<0.01). Conclusion Compared with the conventional abdominal cavity drainage tube fixed method, double butterfly wings raised platform method fixed abdominal cavity drainage tube fixed effect is better, can significantly ease the pain of patients suffer, saved the time nursing.