Pancreatectomia distal no trauma: estudo multicêntrico

Distal pancreatectomy for trauma: a multicenter study

ARTIGOS ORIGINAIS

Pancreatectomia distal no trauma: estudo multicêntrico

Distal pancreatectomy for trauma: a multicenter study

Samir Rasslan, TCBC-SP; Armando Angelo Casaroli, ACBC-SP; Wilson Luiz Abrantes, TCBC-MG; Mário Mantovani, TCBC-SP; Savino Gasparini Neto, TCBC-RJ; Hamilton Petry de Souza, TCBC-RS; Roberto Carlos de Oliveira e Silva, ACBC-MG; João Ricardo Ribas; Luiz Cristiano Maciel Cardoso; Renato de Lima Rosenowicz

^{Endereço para correspondência}

RESUMO

No período de cinco anos, 87 doentes com trauma pancreático foram tratados por pancreatectomia corpo-caudal em cinco serviços de emergência. A idade variou de 7 a 64 anos (média de 28), sendo que 73 (84%) eram do sexo masculino. O principal mecanismo de trauma foi o ferimento penetrante em 72,5%, com ferimentos por projéteis de arma de fogo em 3/4 dos casos. Lesões associadas ocorreram em 96% dos doentes. A extensão da ressecção pancreática correspondeu de 30% a 70%, em 62% dos casos. O baço foi preservado em 45,6% dos 57 doentes que se apresentaram sem lesão esplênica. A taxa de complicações foi de 40,2%, sendo a fístula pancreática e a pancreatite pós-operatória as mais freqüentes. A mortalidade total foi de 12 doentes (13,7%). As conclusões deste estudo foram as seguintes: a) há relação nas taxas de morbidade com o mecanismo de lesão; b) a morbidade é mais freqüente em doentes com trauma fechado; c) não há diferença na incidência de complicações com o método de fechamento do pâncreas remanescente nem com a extensão da ressecção; d) não há relação da mortalidade com o mecanismo de trauma; e) há uma tendência no aumento da taxa de mortalidade no trauma fechado com presença de lesões associadas.

Unitermos: Trauma abdominal; Trauma pancreático; Pancreatectomia no trauma.

ABSTRACT

In a period of five years, 87 patients with pancreatic trauma treated by distal pancreatectomy in five different emergency services were analysed. The age ranged of 7 to 64 years (mean 28) and 73 (84%) were male. The main type of injury was penetrating in 72,5%, with gunshot wounds in 3/4 of cases. Associated injuries were present in 96% of patients. The extension of pancreatic resection involved 30 to 70% of the gland, in 62% of cases. The spleen was preserved in 45,6% of57 patients without splenic injury. Morbidity rate was 46,2% with pancreatic fistula and post-operative pancreatitis the most frequent complications. Mortality rate was 13,7%. The conclusion of this study were: a) There is correlation between morbidity and type of injury; b) post-operative complications were more frequent in blunt trauma; c) There is no difference in the ocurrence of complications with the of method of pancreatic closure; d) There is no correlation between mortality and type of injury; e) There is a trend to increase mortality in blunt trauma with the presence of associated injuries.

Key words: Abdominal trauma; Pancreatic trauma; Pancreatectomy for trauma.

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Recebido em 18/2198

Aceito para publicação em 1/1 0/98

Trabalho realizado nos Serviços de Emergência da Santa Casa de São Paulo, Hospital João XXII de Belo Horizonte, Hospital das Clínicas da Unicamp, Hospital Miguel Couto do Rio de Janeiro e Hospital de Pronto-Socorro de Porto Alegre.

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Endereço para correspondência:

Dr. Samir Rasslan

Rua Marquês de Itú, 837/13

01223-001 - São Paulo-SP.

Datas de Publicação

• Publicação nesta coleção
  31 Maio 2010
• Data do Fascículo
  Dez 1998

Histórico

• Aceito
  01 Out 1998
• Recebido
  18 Fev 1998