[Injuries of pancreatoduodenal organs].
Ten-year experience of treatment of 213 patients with trauma of the pancreas and 56 patients with trauma of the duodenum is analyzed. Combined injury of other organs was seen in 80% patients. Diagnostic policy included intraoperative revision in open abdominal trauma and dynamic observation with US, roentgenography, CT and laboratory tests in closed trauma wich doesn't require urgent surgery. The diagnosis was verified during laparoscopy and contrast duodenography. Surgical treatment results in patients with trauma of the pancreas depending on the variant of surgery are analyzed. The role of drug treatment of traumatic pancreatitis with 5-ftoruracil and octreotid is stressed. It is demonstrated that these principles allowed us to reduce complications rate to 11.7% and lethality to 6.7% from 71.7% and 37.0% respectively. It is established that suturing of duodenal wall on the decompressive nasoduodenal tube is effective within 6 hours after trauma. Later, for prophylaxis of suture insufficiency the duodenum must be switched off. Adequate drainage and depression of secretion with octreotid are very important for success of surgery. In this approach there were no cases of sutures insufficiency among 16 patients in the last 3 years.
Ivanov
P A
PA
Grishin
A V
AV
Korneev
D A
DA
Ziniakov
S A
SA
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000963:Antimetabolites / Q000008:administration & dosage / Q000627:therapeutic use; D004322:Drainage; D004359:Drug Therapy, Combination; D004386:Duodenum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010535:Laparoscopy; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D010195:Pancreatitis / Q000188:drug therapy / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000601:surgery*
D000963:Antimetabolites; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D015282:Octreotide; D005472:Fluorouracil