超声内镜引导下穿刺引流治疗胰腺假性囊肿

目的探讨超声内镜引导下经胃肠壁穿刺置管引流治疗胰腺假性囊肿的疗效及并发症。方法选择2004年8月至2011年3月胰腺假性囊肿患者28例,首先使用线阵型超声内镜扫查,明确病变部位后选择合适穿刺点,导丝沿穿刺针道进入囊肿,沿导丝放置双猪尾硅胶支架1～3支。术后定期随访,囊肿消失后拔除支架。结果本组28例患者,穿刺引流成功25例,成功率为89．3％,其中经胃19例,经十二指肠6例。发生并发症3例,支架移位、出血、感染各1例。随访8—34个月,19例假性囊肿完全消失,6例腹痛症状消失、囊肿明显缩小、但持续存在2年以上,所有患者均未见假性囊肿复发。结论超声内镜引导下经胃肠壁穿刺置管引流术是治疗胰腺假性囊肿的较好方法之一,其疗效确切,并发症少。     

超声引导经皮引流治疗胰腺假性囊肿

目的探讨超声引导经皮引流治疗胰腺假性囊肿(pancreatic pseudocyst,PPC)的临床价值. 方法 2000年12月～2003年10月我院采用超声引导经皮引流治疗PPC 12例,其中单纯穿刺抽液1例,置管引流11例. 结果 1例因囊腔与主胰管相通,改行开腹囊肿空肠Roux-Y吻合术,余11例囊肿消失.引流时间7～90 d,平均28 d.无并发症发生.12例随访6～34个月,平均18个月,1例复发 ,但较引流前明显缩小. 结论超声引导经皮穿刺抽液或置管引流是治疗PPC一种简单可行的方法,具有创伤小,并发症少,早期、多部位、重复治疗等优点.     

超声内镜引导下经胃内置管行胰腺假性囊肿引流术的护理配合

对16例胰腺炎后形成假性囊肿患者在超声内镜引导下经胃内置管行胰腺假性囊肿引流术,术前做好患者和器械准备;术中严密观察病情变化,熟悉操作流程,做好手术配合;术后加强病情监测,积极预防和处理并发症。结果16例中1例置管后囊肿内出血不止,转外科手术治疗后痊愈出院;13例术后1周至8个月经腹部B超、上腹部CT复查显示胰腺假性囊肿消失;2例囊肿并发感染,再放置鼻囊肿引流管反复冲洗,5～6个月后囊肿消失,拔除支架。提出精良的护理配合是手术成功和避免并发症的重要保证。     

超声内镜引导下经胃内置管行胰腺假性囊肿引流术的护理配合

对16例胰腺炎后形成假性囊肿患者在超声内镜引导下经胃内置管行胰腺假性囊肿引流术,术前做好患者和器械准备;术中严密观察病情变化,熟悉操作流程,做好手术配合;术后加强病情监测,积极预防和处理并发症。结果16例中1例置管后囊肿内出血不止,转外科手术治疗后痊愈出院;13例术后1周至8个月经腹部B超、上腹部CT复查显示胰腺假性囊肿消失;2例囊肿并发感染,再放置鼻囊肿引流管反复冲洗,5～6个月后囊肿消失,拔除支架。提出精良的护理配合是手术成功和避免并发症的重要保证。     

经内镜处理胰腺假性囊肿

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。     

胰腺假性囊肿的内镜治疗

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…     

胰腺假性囊肿43例诊治体会

目的探讨胰腺假性囊肿的外科手术治疗方式。方法回顾性分析43例胰腺假性囊肿患者的临床资料,其中行单纯囊肿外引流术8例(18.6%),单纯囊肿切除10例(23.3%),囊肿切除、胰尾部+脾切除术3例(7.0%),囊肿空肠Roux-en-Y吻合19例(44.2%),囊肿胃吻合3例(7.0%)。结果术后发生并发症6例:1例囊肿胃吻合患者术后出现消化道出血,2例单纯囊肿外引流患者发生胰漏,1例囊肿空肠吻合者术后发生逆行感染,切口感染2例。随访37例,复发急性胰腺炎1例。结论胰腺假性囊肿在经保守治疗度过急性期后,应根据病情选择合适的术式治疗。     

胰腺假性囊肿41例诊治体会

目的探讨胰腺假性囊肿的诊断及外科手术治疗方式。方法回顾性分析行手术治疗的41例胰腺假性囊肿患者的临床资料,其中行单纯囊肿外引流术7例（17．1％）,单纯囊肿切除10例（24．4％）,囊肿及胰尾部切除＋脾切除术3例（7．3％）,囊肿空肠Roux-en-Y吻合18例（43．9％）,囊肿胃吻合3例（7．3％）。结果术后发生并发症8例（19．5％）,1例囊肿胃吻合术患者术后2d出现消化道出血,经非手术治疗而痊愈出院;2例患者（单纯囊肿外引流术1例,囊肿空肠Roux-en-Y吻合1例）早期出现不全性肠梗阻,经过保守治疗出院;2例单纯囊肿外引流术患者术后出现胰瘘,1例胰瘘经保守治疗治愈,另外1例因长期胰瘘而再行瘘管空肠吻合术而治愈;1例囊肿空肠Roux-en-Y吻合术后出现逆行感染,经抗炎保守治疗后病情缓解;全组切口感染2例,1例保守换药,另1例换药后行二期缝合均获痊愈。无手术死亡病例。随访37例,时间6个月～5年,平均（3．3±1．9）年,2例单纯囊肿切除术患者于术后1年复发,经保守治疗症状缓解。结论胰腺假性囊肿在经保守治疗渡过急性期后,应根据需要采取个体化的外科治疗方案。     

超声导向胰腺假性囊肿穿刺治疗术

目的探讨超声引导下对胰腺假性囊肿进行穿刺的诊断和治疗价值. 方法对35例胰腺假性囊肿患者实行超声引导下诊断性穿刺(7例)和治疗性穿刺(28例),后者抽出囊液后注药冲洗. 结果 35例患者共52个囊肿均明确诊断并予相应治疗,总成功率100%.随访期间27例胰腺假性囊肿消失,8例复发. 结论超声引导下胰腺假性囊肿穿刺是一种有效而可靠的诊断与非手术治疗方法.     

假性胰腺囊肿经胃外引流术

巨大胰腺假性囊肿（下称囊肿）必须采取外科手术治疗,传统的手术方式采用外引流或内引流术。但二者各有其适应证和优缺点。兼有内、外引流术的优点,而又摒弃了各自缺点的经胃外引流术是治疗巨大胰腺假性囊肿的理想手术方式。我们近４年来采用经胃外引流术治疗巨大胰腺假...     

胰腺假性囊肿的诊治体会

目的 总结胰腺假性囊肿的诊治体会。方法 回顾性分析46例胰腺假性囊肿患者的临床资料，7例保守治疗，行内引流术12例，外引流术9例，序贯式内外引流术5例，胰腺部分切除术13例。结果 保守治疗者均痊愈，无复发；行内引流术者中有1例发生肠瘘，其余11例恢复良好无复发；行外引流术1例出现胰瘘，2例复发；行胰腺部分切除术者有1例出现胰瘘，其余恢复良好。结论 根据病情和病程选择合适的术式是治疗胰腺假性囊肿的关键。     

胰腺假性囊肿治疗方式的选择与评价

目的 对胰腺假性囊肿的治疗方式和效果进行评价。方法 对1990年1月至2002年3月收治的114例胰腺假性囊肿的处理方式、效果及并发症进行回顾性分析。结果 25例未行手术治疗,其中23例在随访期间囊肿自行吸收。CT引导下经皮置管引流组29例,有效率67．85％。外科手术治疗60例,死亡率5％(3／60),手术方式包括：外引流8例,死亡率12．5％(1／8);假性囊肿切除13例;囊肿十二指肠吻合1例;囊肿胃吻合19例,术后消化道出血的发生率为36．8％(7／19),死亡率5．26％(1／19);囊肿空肠Roux-en-Y吻合19例,术后消化道出血的发生率为15．8％(3／19),死亡率5．26％(1／19)。结论 CT引导下经皮置管引流创伤小,操作相对简单,是传统开腹外引流术的有效替代方式。虽然微创技术使胰腺假性囊肿的治疗方式多样化,但仍有不少患者需要外科手术治疗。囊肿胃吻合术后消化道出血的发生率高于囊肿空肠Roux-en-Y吻合术,但多数易于控制,仍然是一种简单合理的内引流术式。对于难以排除恶性的假性囊肿,应尽量手术切除。     

Modified ultrasound-guided percutaneous transgastric drainage of pancreatic pseudocysts

Summary We describe a modified ultrasound-guided transgastric drainage technique for pancreatic pseudocysts. Using a water-filled stomach to improve visualization, we have successfully drained pseudocysts in ten patients. This report also describes the use of a stiffening cannula to assist transgastric catheter placement. We emphasize the value of constant real-time tracking of the dilator and guidewire to ensure correct positioning of the drainage catheter.     

Endoscopic management of pancreatic pseudocyst in children-a long-term follow-up

Background

Literature on long-term outcome after endoscopic management of pediatric pancreatic pseudocyst is not available. The aim of the present study is to report long-term outcome after endoscopic drainage of pancreatic pseudocyst in children.

Methods

Nine patients younger than 15 years, subjected to endoscopic pseudocyst drainage, were included in this study (between 1994 and 2004). Eight patients were subjected to endoscopic cystogastrostomy and stenting, whereas 1 patient was subjected to cystoduodenostomy and stenting. A follow-up of patients was done at 1 month and at 2 to 10 years after drainage. Endoscopic retrograde cholangiopancreatography (ERCP) was done in 2 patients at the time of drainage, and it was repeated in both the patients at the time of final follow-up.

Results

Mean age of the patients was 9.6 years. Trauma was the most common cause (n = 8). Mean follow-up of these patients was 5.7 years (2-10 years). No recurrence was seen in any patient. Endoscopic retrograde cholangiopancreatography revealed complete pancreatic duct block in prevertebral region in 2 posttraumatic patients, and it was persisting on repeat ERCP at final follow-up.

Conclusions

Endoscopic drainage of pancreatic pseudocyst is safe in children with a very good long-term outcome. Pancreatic duct block seen on ERCP may not be clinically important on long-term follow-up.     

Comparison of treatment modalities in pancreatic pseudocyst: A population based study

BACKGROUND Current therapeutic techniques for pancreatic pseudocyst include surgical management with a laparoscopic approach or an open surgical procedure,percutaneous catheter drainage and endoscopic drainage. Yet it remains controversial whether different treatment approaches affect inpatient outcome.AIM To investigate inpatient outcome of different treatment approaches in treating pancreatic pseudocyst.METHODS Here we conducted a retrospective analysis of pancreatic pseudocyst-associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. International Classification of Diseases 10 clinical modification and procedure codes are used.RESULTS A total of 7060 patients meeting the above criteria were identified. Our study revealed laparoscopic approach associated with the lowest rate of red blood cell transfusion(P 0.001), and it had lower short-term complications including acute renal failure(P = 0.01), urinary tract infection(P = 0.01), sepsis(P 0.001) and acute respiratory failure(P = 0.01). Laparoscopic surgical approach associated with the shortest mean length of stay(P = 0.009), and it had the lowest total charge(P = 0.03). All three modalities have similar inpatient mortality(P = 0.28).The study also revealed that percutaneous drainage associated with more emergent admission(P 0.001), rural hospital performs the most open surgical drainage(P 0.001) and patients who received laparoscopic drainage are more likely to be discharged home(P 0.001).CONCLUSION Laparoscopic drainage of pancreatic pseudocysts associated with the least shortterm complications and had better outcomes comparing to percutaneous and open surgical drainage from 2016 National Inpatient Sample database.     

Endoscopic drainage of pancreatic pseudocysts

Summary Seventeen patients with pancreatic pseudocysts were treated by endoscopic drainage. In nine cases we performed endoscopic retrograde pancreatic drainage (ERPD) by inserting 7-Fr pigtail catheters via the papilla into the cyst or into the main pancreatic duct. In two cases transduodenal cystotomy (ECD) and in eight cases transgastral cystotomy (ECG) are performed by using coagulator and papillotome. In five cases of ECG an endoprosthesis was inserted into the cyst. In two cases combination therapy of ERPD and ECG was performed. All patients reported reduction of continuous pain and postprandial epigastralgia after placement of endoprosthesis. After disappearance of symptoms and abnormal endoscopic findings within a period of 2–12 months the drainage tubes were removed. In one case postoperative dislocation of the prosthesis was observed; no serious complication was not encountered. The period of observation varied from 5 to 40 months. Two patients are presently under treatment with endoprostheses. Endoscopic drainage yielded good results in the treatment of pancreatic pseudocysts.     

Minilaparoscopic transgastric cystgastrostomy

BACKGROUND: A technique combining upper endoscopy with percutaneous transgastric minilaparoscopic instrumentation for the formation of pancreatic cystgastrostomy is safe and effective for the internal drainage of pancreatic pseudocysts. METHODS: At a tertiary-care academic medical center, 6 patients with pancreatic pseudocysts with a mean size of 19 cm (range, 16-23 cm) were selected for combined endoscopic and percutaneous transgastric minilaparoscopic (1.7-2 mm) pancreatic cystgastrostomy. All pseudocysts had been followed-up for a minimum of 5 weeks (range, 5-22 wk) and were noted to significantly displace the stomach anteriorly. RESULTS: The mean surgical time was 98 minutes (range, 45-150 min). The mean amount of fluid removed from the pseudocysts was 2167 mL (range, 1600-2600 mL). All ports were removed from the stomach without the need to suture the gastric wall or skin except for 2 gastric serosal sites that were closed with a single intracorporeal stitch. The length of hospital stay averaged 2.2 days (range, 0-6 d). All patients were discharged in good condition, tolerating a regular diet. With a mean follow-up period of 13.4 months (range, 1-30 mo), all patients remain asymptomatic from their pancreatic pseudocysts. CONCLUSIONS: The technique of combining upper endoscopy with percutaneous transgastric minilaparoscopic instruments to create a pancreatic cystgastrostomy can be used to apply well-established surgical principals for internal drainage and has the potential to be used for the management of other gastric pathology.     

腹腔镜技术在胰腺假性囊肿空肠Roux-en-Y吻合术中的应用

目的 探讨腹腔镜下囊肿空肠Roux-en-Y吻合技术在治疗胰腺假性囊肿手术中的可行性、安全性及其临床应用价值.方法 回顾分析近年收治的胰腺假性囊肿患者4例,实施完全腹腔镜下囊肿空肠Roux-en-Y吻合术.观察患者的术中出血量、手术时间、术后下床时间、排气排便时间、术后并发症、住院时间及随访结果.结果 所有手术均顺利无中转开腹.平均手术时间约90 min,出血量约40 ml,术后约1.5 d下床,2.3 d排气或排便.患者均顺利恢复,无胰漏等并发症发生.平均住院时间为7d.术后随访2年,无发热腹痛、无胰腺炎和肠粘连等并发症发生,无复发.结论 完全腹腔镜胰腺假性囊肿空肠Roux-en-Y吻合术是安全可行的,具有创伤小、恢复快及并发症少等优点,值得推广.其中掌握精湛的腹腔镜技术和娴熟的打结技巧至关重要.

Abstract：

Objective To explore the feasibility, safety and clinical value of laparoscopic Rouxen-Y cystojejunostomy in the treatment of pancreatic pseudocyst. Method Four patients with pancreatic pseudocyst received totally laparoscopic pancreatic pseudocystojejunostomy. The data on intraoperative bleeding, operative time, postoperative time to get out of bed, time of first flatus/bowel motion, complication and duration of hospital stay were collected and analyzed retrospectively. Results All operations were carried out successfully with laparoscopic surgery. The mean operative time was 90 min. The average intraoperative blood loss was 40 ml. The mean postoperative time to get out of bed was 1.5 d, and the mean time of first flatus/bowel motion was 2. 3 d. All patients recovered smoothly without any pancreatic fistula. The average hospital stay was 7 days. Fever, pancreatitis,adhesive intestinal obstruction and other complications did not occur. Conclusions Totally laparoscopic Roux-en-Y pancreatic pseudocystojejunostomy was an efficacious, safe, and minimally invasive procedure.