2009-4

.: Дата публікації 2009-12-22 :: Переглядів: 8 :: :.

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PANCREAS DAMAGE AT PLURAL AND MULTIPLY TRAUMA
F.M. Novikov, O.A. Tkachenko, I.O. Vorobey, O.V. Vorobey, O.V. Dopiryak, І.L. Brylenko

The aim — a surgical tactic analysis for the optimization and surgical treatment results improvement and diagnostic measures improvement in patients with pancreas damage.

Materials and methods. The surgical treatment results were analyzed in 46 clinical cases – patients with multiply trauma (poly trauma) with the pancreas damage from 2001 to 2008. men From them were – 44 (95.6 %), women – 2 (4.4 %) patients. Middle ages was – 39.5 years. 17 (36.9 %). were In a state of alcoholic intoxication. The closed abdominal trauma with the pancreas damage was in 31 (67.4 %), open wounds with the damage of pancreas – in 14 (30.4 %), gunshot wound – in 1 (2.2 %) victims. Damages of pancreas were combined with the trauma of other organs of abdominal region. The trauma of stomach with the damage of pancreas was combined with a skeletal trauma in 15 (48.4 %) cases, with a cranial-cerebral trauma was found out combination in 17 (54.8 %) victims, in 8 (25.8 %) cases the trauma of abdominal region was combined with the trauma of thorax.

Results and discussions. Surgical tactic and extension were established depending on trauma size and localization. In 8 (17.4 %) cases the total transversal rupture was revealed, the pancreatic head trauma was in 21 (45.7 %), head and caudal injury as revealed in 17 (36.9 %) cases. Ductal system was damaged in 3 cases of pancreatic head injury. 18 (39.1 %) suture plication, 8 (17.4 %) distal resections in 4 cases with splenectomy were performed. In 20 (43.5 %) cases operation was finished by omental drainage in 24 (52.2 %) – by cholecystectomy with external drainage by Holsted.In 9 (19.6 %) cases cholecystostomy was used. In 13 (28.2 %) cases the drainage as not. mean stay duration in hospital in victims with the pancreas damages which convalesced was 17.9 days. 18 (39.1 %) victims died in a after operative period, in 4 cases were early in first 24 hours lethality (8.7 %). Mean bed-day for dying patients was 5.3. Complication in postoperative period: protracted intestine paresis – in 11 (23.9 %) cases, pancreatic fistula - in 3 (6.5 %), postoperative wound suppuration – in 4 (8.7 %). Relaparotomy through complication was in 4 patients.

Conclusions. Abdominal trauma with the pancreas damage is the extraordinarily severe injury, which is accompanied with high lethality (39.1 %). Much pancreatic injuries are diagnosed during operation. The postoperative course, medical therapy, as well as complications of pancreatic injuries have similar pathogenesis picture with acute pancreatitis.