The Management of Pancreatic Injuries During Laparoscopic Urologic Surgery / 医学研究杂志

ABSTRACT

Objective To summarize the management experiences of pancreatic injuries during laparoscopic urologic surgery.Methods From June 2003 to August 2008,395 laparoscopic operations for upper urinary or adrenal diseases were performed.4 cases of pancreatic injuries which all occurred in left side introperiotoneal procedures were identified with the incidence of 1%.2 men and 2women were involved with the mean age of 45.3(range 32~76y).2 injuries occurred during left radical nephrectomy and 2 during left adrenalectomy.All the injuries located at tail of pancreas with transaction injuries in 2 cases,and mild laceration in 2 cases.Only 1 case had received open surgery for pancreatic debridement,another 3 cases had received clamp and endo-GIA occlusion laparoscopically with local styptic powder aspersing and drainage.Absolute diet,gastrointestinal decompression,,transvenous-use of Somatostatin and hyperalimentation were given routinely.Results The mean blood,urine and drainage fluid diastase that were(648?136)U、(1278.6?368.4)U and(1368.5?428.2)U respectively elevated in all 4 cases postoperatively.Only 1 case had high fever and blood WBC after operation.The mean drainage and hospital stay was 14.2 and 24.6 days.No sequelae was found.Conclusion The tail of pancreas is the most predilecting location of pancreatic injury in laparoscopic urological surgery.The key of ensuring a good prognosis is early detection and suitable management.A severe laceration of the main excretory pancreatic duct need a open surgical management,conservative managements are suitable for a small tear and mild contusion of pancreas.