PDF(Pubmed)
Abstract：
BACKGROUND: A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a complete disruption of the MPD involved distal pancreatic resection and pancreaticojejunostomy Roux-en-Y anastomosis. Nevertheless, there have been no reported cases of hybrid surgery being employed for the complete disruption of the MPD.
METHODS: A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck.
METHODS: Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV.
METHODS: The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct.
RESULTS: The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction.
CONCLUSIONS: The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.
METHODS: A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck.
METHODS: Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV.
METHODS: The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct.
RESULTS: The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction.
CONCLUSIONS: The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.
摘要：
背景：主胰管（MPD）的完全破坏对外科医生提出了重大挑战。历史上,解决MPD完全中断的标准手术方法包括远端胰腺切除和胰肠吻合术Roux-en-Y吻合术.然而，目前尚无报道采用杂交手术完全破坏MPD的病例.
方法：一名63岁的男性患者出现上腹部钝器伤，受伤10小时后被转移到我们的创伤中心。到达急诊室后，他有意识,血液动力学稳定，并抱怨上腹痛和腹胀。体格检查显示右上腹部压痛和轻微的腹部张力。腹部对比增强CT扫描显示，在头颈部交界处胰腺实质完全横切。
方法：头颈部连接处的胰腺实质完全横切，并完全破坏MPD，AIS四级。
方法：混合手术最初用于完全MPD破坏，在MPD中纳入内窥镜辅助支架置入以及胰腺实质和导管的初步修复。
结果：术后进展顺利，术后4周患者康复出院。术后4个月在内镜下取出MPD支架,内镜逆行胰管造影检查显示MPD通畅，MPD轻度狭窄，无胰漏。在最近的随访中，患者已恢复正常生活和工作，无任何胰腺内分泌或外分泌功能障碍。
结论：混合手术，结合内窥镜辅助的MPD支架放置和胰腺实质和导管的初次修复，在血流动力学稳定的患者中出现完全MPD破坏的有希望的替代方案。这种混合手术的挑战是MPD远端的精确定位。
方法：一名63岁的男性患者出现上腹部钝器伤，受伤10小时后被转移到我们的创伤中心。到达急诊室后，他有意识,血液动力学稳定，并抱怨上腹痛和腹胀。体格检查显示右上腹部压痛和轻微的腹部张力。腹部对比增强CT扫描显示，在头颈部交界处胰腺实质完全横切。
方法：头颈部连接处的胰腺实质完全横切，并完全破坏MPD，AIS四级。
方法：混合手术最初用于完全MPD破坏，在MPD中纳入内窥镜辅助支架置入以及胰腺实质和导管的初步修复。
结果：术后进展顺利，术后4周患者康复出院。术后4个月在内镜下取出MPD支架,内镜逆行胰管造影检查显示MPD通畅，MPD轻度狭窄，无胰漏。在最近的随访中，患者已恢复正常生活和工作，无任何胰腺内分泌或外分泌功能障碍。
结论：混合手术，结合内窥镜辅助的MPD支架放置和胰腺实质和导管的初次修复，在血流动力学稳定的患者中出现完全MPD破坏的有希望的替代方案。这种混合手术的挑战是MPD远端的精确定位。
