Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damag...Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damage control surgery (DCS) has been increasingly accepted. DCS展开更多
Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries.Methods: A retrospective study was done on 37 patients with severe thoracic and ...Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries.Methods: A retrospective study was done on 37 patients with severe thoracic and abdominal injuries who underwent damage control surgery from January 2000 to October 2006 in our department. There were 8 cases of polytrauma ( with thoracic injury most commonly seen), 21 of polytrauma (with abdominal injury most commonly seen) and 8 of single abdominal trauma. Main organ damage included smashed hepatic injuries in 17 cases,posterior hepatic veins injuries in 8, pancreaticoduodenal injuries in 7, epidural or subdural hemorrhage in 4,contusion and laceration of brain in 5, severe lung and bronchus injuries in 4, pelvis and one smashed lower limb wound in 3 and pelvic fractures and retroperitoneal hemorrhage in 6. Injury severity score (ISS) was 28-45 scores (38.4 scores on average), abbreviated injury scale (ALS) ≥ 4.13. The patients underwent arteriography and arterial embolization including arteria hepatica embolization in 4 patients, arteria renalis embolization in 2 and pelvic arteria retroperitoneal embolization in 7. Once abbreviated operation finished, the patients were sent to ICU for resuscitation. Twenty-four cases underwent definitive operation within 48 hours after initial operation, 5 underwent definitive operation within 72 hours after initial operation, 2 cases underwent definitive operation postponed to 96 hours after initial operation for secondary operation to control bleeding because of abdominal cavity hemorrhea.Two cases underwent urgent laparotomy and decompression because of abdominal compartment syndrome and 2 cases underwent secondary operation because of intestinal fistulae (1 case of small intestinal fistula and 1 colon fistula) and gangrene of gallbladder.Results: A total of 28 patients survived, with a survival rate of 75.68%, and 9 died (4 died within 24 hours and 5 died 3-9 days after injury). The trauma deaths at the early stage were caused by severe primary injuries resulting in failure of respiration and circulation, while mortality at the later stage was caused by multiple organ failure.Conclusions: Damage control surgery is important for the treatment against severe thoracic and abdominal injuries. It is suggested that the surgeon should select the reasonable auxiliary examination before operation, and take the proper time to perform damage control and definitive surgery.展开更多
Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined ...Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components:(1)A 50 m×50 m square yard was constructed as the explosion site.Safety was assessed through cameras.(2)Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group(accepted DCS)and the control group(have not accepted DCS).The mortality rate was observed.(3)The literature was reviewed to identify the key factors for assessing CDCS,and testing standards for CDCS were then established.Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Then,a 5-day training course with incorporated tests was used to test the efficacy of the established platform.In total,30 teams attended the first training course.The scores that the trainees received before and after the training were compared.SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall.No pig died within 24 h when DCS was performed,while 7 pigs died in the control group.After a literature review,assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts:leadership and team cooperation,resuscitation,surgical procedure,and final outcome.Expert questionnaire results showed that the scientific score was 8.6±1.25,and the feasibility score was 8.74±1.19.When compared with the basic level,the trainees’score improved significantly after training.展开更多
BACKGROUND The management of high-grade pancreatic trauma is controversial.AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.METHODS A retrospectiv...BACKGROUND The management of high-grade pancreatic trauma is controversial.AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma(AAST) Grade Ⅲor greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for highgrade injuries. Seven patients sustained AAST Grade Ⅲinjuries and 7 were classified as Grades Ⅳ or Ⅴ. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy(PD). Overall, there was a predominance of blunt aetiologies(11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases(7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepatopancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.展开更多
基金The study is supported by a grant from special project of Chinese Military Medicine Science and Technology Research "11.5" plan (No. 06Z017).
文摘Pancreatic trauma as a challenge before and during explorative laparotomy is associated with multiple visceral injuries or critical conditions. Its optimal management remains controversial.The current concept of damage control surgery (DCS) has been increasingly accepted. DCS
文摘Objective: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries.Methods: A retrospective study was done on 37 patients with severe thoracic and abdominal injuries who underwent damage control surgery from January 2000 to October 2006 in our department. There were 8 cases of polytrauma ( with thoracic injury most commonly seen), 21 of polytrauma (with abdominal injury most commonly seen) and 8 of single abdominal trauma. Main organ damage included smashed hepatic injuries in 17 cases,posterior hepatic veins injuries in 8, pancreaticoduodenal injuries in 7, epidural or subdural hemorrhage in 4,contusion and laceration of brain in 5, severe lung and bronchus injuries in 4, pelvis and one smashed lower limb wound in 3 and pelvic fractures and retroperitoneal hemorrhage in 6. Injury severity score (ISS) was 28-45 scores (38.4 scores on average), abbreviated injury scale (ALS) ≥ 4.13. The patients underwent arteriography and arterial embolization including arteria hepatica embolization in 4 patients, arteria renalis embolization in 2 and pelvic arteria retroperitoneal embolization in 7. Once abbreviated operation finished, the patients were sent to ICU for resuscitation. Twenty-four cases underwent definitive operation within 48 hours after initial operation, 5 underwent definitive operation within 72 hours after initial operation, 2 cases underwent definitive operation postponed to 96 hours after initial operation for secondary operation to control bleeding because of abdominal cavity hemorrhea.Two cases underwent urgent laparotomy and decompression because of abdominal compartment syndrome and 2 cases underwent secondary operation because of intestinal fistulae (1 case of small intestinal fistula and 1 colon fistula) and gangrene of gallbladder.Results: A total of 28 patients survived, with a survival rate of 75.68%, and 9 died (4 died within 24 hours and 5 died 3-9 days after injury). The trauma deaths at the early stage were caused by severe primary injuries resulting in failure of respiration and circulation, while mortality at the later stage was caused by multiple organ failure.Conclusions: Damage control surgery is important for the treatment against severe thoracic and abdominal injuries. It is suggested that the surgeon should select the reasonable auxiliary examination before operation, and take the proper time to perform damage control and definitive surgery.
基金Key logistics scientific project of the "Thirteenth Five Year Plan" of Medical Research of PLA(ALJ19J001)Key Clinical Innovation Project of XinQiao Hospital and Army Medical University(2018JSLC0023/CX2019JS107)
文摘Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components:(1)A 50 m×50 m square yard was constructed as the explosion site.Safety was assessed through cameras.(2)Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group(accepted DCS)and the control group(have not accepted DCS).The mortality rate was observed.(3)The literature was reviewed to identify the key factors for assessing CDCS,and testing standards for CDCS were then established.Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Then,a 5-day training course with incorporated tests was used to test the efficacy of the established platform.In total,30 teams attended the first training course.The scores that the trainees received before and after the training were compared.SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall.No pig died within 24 h when DCS was performed,while 7 pigs died in the control group.After a literature review,assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts:leadership and team cooperation,resuscitation,surgical procedure,and final outcome.Expert questionnaire results showed that the scientific score was 8.6±1.25,and the feasibility score was 8.74±1.19.When compared with the basic level,the trainees’score improved significantly after training.
基金Research protocol was approved by the Northern Sydney Local Health District ethics committee as a negligible/Low risk project.This study was not a trial or animal study.
文摘BACKGROUND The management of high-grade pancreatic trauma is controversial.AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma(AAST) Grade Ⅲor greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for highgrade injuries. Seven patients sustained AAST Grade Ⅲinjuries and 7 were classified as Grades Ⅳ or Ⅴ. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy(PD). Overall, there was a predominance of blunt aetiologies(11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases(7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepatopancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.
