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经内镜处理胰腺假性囊肿 总被引:1,自引:0,他引:1
汪和金 《国外医学(外科学分册)》1998,25(3):133-134
经内镜引流胰腺假性囊中获得与剖腹手术相似的结果,但其创伤小,并发症少,凡在囊壁厚度不足1cm并向胃,十二指肠腔内突出者应列为首选治疗方法。 相似文献
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胰腺假性囊肿的内镜治疗 总被引:3,自引:0,他引:3
胰腺假性囊肿(pancreaticpseudocyst,PPC)是指各种病因所致的胰腺内或其邻近间隙的富含胰分泌物的积液,但形成的囊壁缺乏上皮衬里。它是急、慢性胰腺炎的常见并发症,总发生率为1%~4.5%[1]。PPC有急性和慢性之分,两者的发病机理、发展结局和治疗方法是不同的[1]。所谓急性PPC通常是在急性胰腺炎基础上的急性胰周积液,其发生率为10%~27%,但它们的绝大多数能自行消退。大约20%的慢性胰腺炎病人发生慢性PPC,其有成熟的假性囊壁,总是与胰管交通,伴胰管狭窄,因此不易消退[1… 相似文献
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假性胰腺囊肿的外科治疗 总被引:3,自引:0,他引:3
假性胰腺囊肿的外科治疗广州海员医院(510300)吴水来,陈敬迈作者从1986年7月至1994年8月共手术治疗假性胰腺囊肿12例,现结合文献,对该病有关问题进行讨论。临床资料一般资料:本组12例均为男性,年龄36~55岁,平均46.1岁。12例均有饮... 相似文献
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胰腺假性囊肿诊治体会 总被引:1,自引:1,他引:1
回顾性分析近15年来对23例胰腺假性囊肿的治疗情况。保守治愈5例,均为近期患急性胰腺炎者;手术治疗18例,其中外引流1例,内外流14例,囊肿切除术3例。结果 无手术死亡,外引流术后胰瘘1例,囊肿切除术后复发1例,内引流术后无严重并发症出现。认为急性囊肿应观察6周,有些病例有自行消散的可能,慢性囊肿一经确诊即行内流引治疗,内引流是目前较理想的有效手术方式。 相似文献
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患者女性 ,40岁。于半年前无明显诱因出现左上腹隐痛 ,阵发性加剧 ,并向左腰部及肩部放射 ,同时呕吐多次 ,为当餐食物。自觉畏寒、寒颤与发热。在医院检查体温 39℃ ,脉搏细弱 ,血压测不出 ,尿淀粉酶 30 0单位 (温氏法 )。经输液等抢救后血压上升 ,病情好转 ,但体温持续 38℃~ 39℃ 1个多月后方退。退热后无任何不适 ,开始恢复工作。入院前10余天感乏力 ,全腹持续隐痛 ,以中上腹明显。 3~ 4d后腹痛移至左下腹 ,并有阵发性加剧 ,无畏寒、发热与呕吐。同时自已扪及中上腹有一鸭蛋大包块 ,经检查证实 ,以“腹部包块待查”收入院。体检 :体温… 相似文献
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Purpose
We present a case report of a novel hybrid natural orifice transluminal endoscopic surgery (NOTES). The operation performed was a transgastric cystgastrostomy with endoscopic guidance for a pancreatic pseudocyst. This operation was completed entirely through an existing gastrostomy site with no incisions, thus avoiding the peritoneal cavity.Methods
This is a case of a 7-year-old boy with neurologic impairment from congenital herpes simplex virus encephalitis who is tube fed. He had acute pancreatitis and developed a 9 cm pancreatic pseudocyst. The pseudocyst failed to resolve after 6 weeks and developed a mature wall. Due to a history of multiple abdominal surgeries and known abdominal adhesions, a minimally invasive approach that would avoid entering the peritoneal cavity was the desired approach. The technique involved a trans-oral endoscope for visualization and the use of the gastrostomy as access to the gastric lumen and pseudocyst. The pancreatic pseudocyst was stabilized with two T-fasteners and confirmed with needle aspiration under endoscopic visualization. The pseudocyst was then opened with the LigaSure (Valleylab, Boulder, CO). The cystgastrostomy anastomosis was completed with an Endopath ETS-Flex Articulating Linear Stapler/Cutter (Ethicon Endo-Surgery, Inc, Cincinnati, OH). The operation took less than 2 hours and was completed without an incision. Under the policies of the Human Research Protection Program, review of a single case is outside the scope of the definition of human subjects research and does not require institutional review board review and approval.Results
The patient did well postoperatively and had a dramatic reduction in size of the pancreatic pseudocyst to 3.5 cm by 2 weeks.Conclusions
Hybrid NOTES cystgastrostomy performed through an existing gastrocutaneous fistula is an excellent approach for minimally invasive drainage of pancreatic pseudocysts. 相似文献12.
Hiroyuki Isayama Keisuke Yamamoto Suguru Mizuno Yoko Yashima Osamu Togawa Hirofumi Kogure Takashi Sasaki Naoki Sasahira Yousuke Nakai Kenji Hirano Takeshi Tsujino Minoru Tada Takao Kawabe Masao Omata 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):270-273
Endoscopists seek to conduct more aggressive surgical procedures that surpass the limitations of existing endoscopic procedures.
Endoscopic pancreatic necrosectomy and natural orifice transluminal endoscopic surgery (NOTES) are typical examples of this
new trend; both are performed through the gastrointestinal wall without a skin incision. Endoscopic necrosectomy is effective
for managing organized pancreatic necrosis and abscesses. The necrotic tissues are removed endoscopically by directly entering
the cavity of the organized pancreatic necrosis. NOTES is a possible advance over surgical intervention, as it is a less invasive,
more cosmetic, and effective procedure. There are various approaches, including the esophagus, stomach, colon, and vagina;
Various procedures are possible using NOTES, such as cholecystectomy, appendectomy, full-thickness stomach resection, splenectomy,
gastrointestinal (GI) anastomosis, and peritoneoscopy. The requirements for NOTES include high proficiency in endoscopic techniques,
including knowledge of various devices, anatomy, and surgical procedures. Since most GI endoscopists have no surgical background,
to increase the usage of NOTES, GI endoscopists should form and lead teams that include various specialists. We believe that
endoscopic necrosectomy and NOTES represent a major shift in the treatment paradigm because physicians can treat beyond the
gastrointestinal wall and endoscopic procedures will replace surgical treatment. 相似文献
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Ultrasound-directed percutaneous endoscopic cyst-gastrostomy for the treatment of a pancreatic pseudocyst 总被引:2,自引:0,他引:2
The incidence of pseudocysts in patients with chronic pancreatitis ranges from 20–40%. Unlike pseudocysts associated with
acute pancreatitis, these do not usually resolve spontaneously. Traditionally, these cysts were drained surgically. More recently,
however, they have been successfully managed with endoscopic drainage. This report reviews the history and results of nonsurgical
pseudocyst management and describes a case of drainage obtained using an alternative method of ultrasound-directed percutaneous
endoscopic cyst-gastrostomy.
Received: 22 August 1997/Accepted 20 November 1997 相似文献
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BACKGROUND: Experience with minimal access, transoral/transmural endoscopic drainage/debridement of walled-off pancreatic necrosis (WOPN) after necrotizing pancreatitis is limited. We sought to determine outcome using this technique. METHODS: Retrospective analysis. RESULTS: From 1998 to 2006, 53 patients underwent transoral/transmural endoscopic drainage/debridement of sterile (27, 51%) and infected (26, 49%) WOPN. Intervention was performed a median of 49 days (range, 20-300 days) after onset of acute necrotizing pancreatitis. A median of 3 endoscopic procedures/patient (range, 1-12) were performed. Twenty-one patients (40%) required concurrent radiologic-guided catheter drainage of associated or subsequent areas of peripancreatic fluid and/or WOPN. Twelve patients (23%) required open operative intervention a median of 47 days (range, 5-540) after initial endoscopic drainage/debridement, due to persistence of WOPN (n = 3), recurrence of a fluid collection (n = 2), cutaneous fistula formation (n = 2), or technical failure, persistence of pancreatic pain, colonic obstruction, perforation, and flank abscess (n = 1 each). Final outcome after initial endoscopic intervention (median, 178 days) revealed successful endoscopic therapy in 43 (81%) and persistence of WOPN in 10 (19%). Preexistent diabetes mellitus, size of WOPN, and extension of WOPN into paracolic gutter were significant predictive factors for need of subsequent open operative therapy. CONCLUSIONS: Successful resolution of symptomatic, sterile, and infected WOPN can be achieved using a minimal access endoscopic approach. Adjuvant percutaneous drainage is necessary in up to 40% of patients, especially when WOPN extends to paracolic gutters or pelvis. Operative intervention for failed endoscopic treatment is required in about 20% of patients. 相似文献
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Maki Sugimoto 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):247-248
Introduction Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent
the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations.
It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led
to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006.
Materials and methods In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including
NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss
the potential benefits of these procedures in hepatobiliary and pancreatic surgery.
Conclusion We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously
advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use
of their specialties. 相似文献
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Reoperations for pancreatic pseudocyst 总被引:1,自引:0,他引:1
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NOTES-经自然腔道(阴道)内镜下胆囊切除术31例 总被引:4,自引:0,他引:4
目的:探讨临床开展经自然腔道(阴道)内镜下胆囊切除术的可行性、安全性和优越性。方法:31例胆囊疾病患者行经阴道内镜下胆囊切除术。脐下缘做-5mm切口,置入腹腔镜引导胃镜和NOTES操作器械经阴道后穹窿15mm切口进入腹腔。胃镜获得稳定图像后,撤出脐部腹腔镜置入普通腹腔镜操作器械。在胃镜监视下,通过脐部和阴部两把操作器械完成胆囊切除术。结果:31例患者均顺利完成经阴道内镜胆囊切除术。手术时间60~150min,平均85min。未放置引流,无出血、胆瘘等并发症发生。腹壁无明显瘢痕遗留,术后疼痛轻微,平均住院日缩短,医疗花费鼎氏。结论:经阴道内镜下胆囊切除术技术可行,操作安全,相比传统腹腔镜手术有明显优越性,建议在有剽牛的医院逐步推广应用。 相似文献
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Shah SA Abdullah MT Kakar AH Zubair M 《Journal of the College of Physicians and Surgeons--Pakistan : JCPSP》2012,22(5):325-327
A 56 years old man presented with epigastric pain and abdominal distension. He suffered an attack of acute pancreatitis 6 weeks back followed by pseudopancreatic cyst formation. As the cyst kept on enlarging in size despite being on conservative management, the patient was operated after 5 weeks. A huge pancreatic pseudocyst was found containing about 4.5 liters of fluid. Cystogastrostomy was performed and the patient recovered un-eventfully. It was the third largest pancreatic pseudocyst reported so far. 相似文献