췌십이지장 손상에서의 응급췌십이지장절제술 (Emergency Pancreaticoduodenectomy for Severe Pancreaticoduodenal Injury)

서지정보

· 발행기관 : 대한외상학회
· 수록지 정보 : 대한외상학회지 / 25권 / 4호 / 115 ~ 121페이지
· 저자명 : 박인규, 황윤진, 권형준, 윤경진, 김상걸, 천재민, 박진영, 윤영국

초록

Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries.
Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations,mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed.
Results: The mean age of the 16 patients was 45±12 years (mean±standard deviation), and 15(93.8%)patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple’s operation, and 1patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%),delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD.
Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be con-sidered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries,provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.

영어초록

Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries.
Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations,mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed.
Results: The mean age of the 16 patients was 45±12 years (mean±standard deviation), and 15(93.8%)patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple’s operation, and 1patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%),delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD.
Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be con-sidered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries,provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.

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