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asbryobvrz · Wysłany: Śro 13:25, 09 Mar 2011

Early diagnosis of blunt pancreatic trauma and first-aid strategy

The most important step strategy is the basis of treatment success or failure. Incidence of 69 cases reported in patients with pancreatic injury, surgery within 8 hours of postoperative complications was 18%. 24 hours after onset of surgery complication rate can be increased to 50% t2 ~. As of early pancreatic atypical abdominal symptoms and signs in diagnosis Author: 361000 Xiamen Siming District, Xiamen, Guangdong Province People's Hospital (Liu Yu); Second Affiliated Hospital of Zhejiang University (Yuan Xiaojuan) Liu Yu Yuan Xiaojuan Table 1 two groups of grade, number of complications and death cases should be careful to compare the means of early diagnosis and standards: In addition to clinical symptoms and signs, laboratory examinations of pancreatic injury means of emergency including blood and urine amylase determination, abdominal paracentesis, abdominal B- and CT. There are other means of MRCP examination recently. Amylase in this group underwent examination, including 8 cases of early blood and urine amylase-positive (61.5%), late group of 6 cases of blood and urine amylase were positive. Urine amylase positive rate is low because of early injuries may be a short time, inhibition of pancreatic exocrine function, so no blood amylase increased significantly. However, due to spillover. Abdominal paracentesis fluid significantly increased amylase values, if significantly higher than the level of serum amylase,[link widoczny dla zalogowanych], early diagnosis is more clear. Group of 11 cases in this group of early abdominal puncture or lavage, there were 10 cases of amylase increased,[link widoczny dla zalogowanych], but should be noted that the increase of amylase and the severity of the disease is not directly proportional. Radiographic, CT diagnosis of high value. However, in hospital, sometimes B-ultrasound may be more important. Enhanced abdominal CT is often required to help correct diagnosis, CT because of emergency conditions when the time line may not be enhanced CT. The group of 10 early group only 1 case of routine CT examination to obtain the correct diagnosis before surgery,[link widoczny dla zalogowanych], and 6 patients with advanced CT examination in 5 cases of pancreatic injury site can be displayed. But not clear whether the main pancreatic duct rupture. B-manifestations were diffuse swelling of the pancreas, showed weak echo. Show sparse gray spot. Hemorrhagic pancreatitis, showing uneven, irregular strong echo, irregular contour. Slight expansion of the pancreatic duct. However, due to intestinal gas interference. B ultrasound diagnosis rate is often not high, this group was 33% (6 / 19). Among the early group 1 patients, 5 cases later. Recently MRCP in the diagnosis of pancreatic injury applications increased, in terms of permitting time lines may be CT and MRCP examination. Our hospital because of the limited conditions, no relevant information on the check, but the literature 333. Diagnosis and Treatment. Reports, MRCP diagnosis of pancreatic fracture have a higher value. To sum up. Check each of the above limitations,[link widoczny dla zalogowanych], preoperative diagnosis is difficult, early diagnosis of pancreatic injury is still a problem. On the basis of the correct diagnosis. According to the degree of pancreatic injury, the use of reasonable treatment. Is to improve the success rate and reduce the complications of the premise. Such as early access to diagnosis, early surgical exploration should be, unless the general good, no abdominal signs, no preoperative imaging performance of the main pancreatic duct injury. Such as the exclusion of other concurrent injuries. Before trial in intensive care under conservative treatment. Conservative treatment is limited to I, Ⅱ grade of pancreatic injury. However, any surgery should be well prepared, so as not to delay timing of surgery. This group of early postoperative complications and mortality group were significantly less than the late group. In addition,[link widoczny dla zalogowanych], more recent emphasis on medical treatment of pancreatic injury damage control surgery (damagecontrolsurgeryDCS1 the concept of population, for a hemodynamically unstable patients. As soon as controlling bleeding, and then deal with possible perforation or rupture of hollow organs. If necessary First to filling, drainage, temporary measures such as temporary closure of the end of abdominal surgery, stable condition, creating opportunities for the final restoration. In short, the early pancreatic difficult to find time to deal with postoperative complications and mortality of greater impact. preoperative take a variety of diagnostic measures for the early diagnosis. to take the appropriate surgical approach, if necessary, combined with the concept of damage control surgery. to improve the success rate of treatment of severe pancreatic injury is important.