腹腔镜序贯外内引流术治疗胰腺假性囊肿的疗效观察

目的:探讨腹腔镜序贯外内引流术治疗胰腺假性囊肿的临床价值。方法:回顾分析2008年7月至2018年6月收治的56例胰腺假性囊肿患者的临床资料,分为腹腔镜序贯外内引流组(观察组)与经皮穿刺组(对照组),观察两组手术时间、出血量、住院时间、术后带管时间、并发症发生率、短期影像学缓解率、长期影像学缓解率及复发率等情况,评价两种术式的疗效。结果:两组均顺利完成操作,无围手术期死亡,观察组4例同时行腹腔镜胆囊切除术。观察组术后带管时间[(32.69±2.46)d vs.(34.56±2.60)d]、术中出血量[(23.33±5.92)mL vs.(28.69±4.24)mL]、并发症发生率(3.0%vs.26.1%)、长期影像学缓解率(100.0%vs.73.9%)及复发率(0 vs.17.4%)优于对照组,差异有统计学意义。两组短期影像学缓解率(100%vs.91.3%)、住院时间[(8.45±1.06)d vs.(9.95±4.18)d]差异无统计学意义。结论:腹腔镜序贯外内引流术安全、可靠,效果肯定,可作为治疗胰腺假性囊肿的合理术式。     

腹腔镜序贯式外、内引流术治疗胰腺假性囊肿

“序贯式外、内引流术”是彭淑牖教授设计的治疗胰腺假性囊肿的理想术式[1],在临床及实验研究中均取得了令人满意的效果[2,3]。为了充分发挥序贯式外、内引流术的优点而最大限度地减轻病人的痛苦,我们在大量腹腔镜手术的基础上,成功进行了腹腔镜下序贯式外、内引流术,现介绍如下。手术方法病人仰卧位,气管插管下全身麻醉。于脐上方作1cm小切口,以气腹针穿刺常规建立气腹,再以直径1cm套管针穿刺,插入腹腔镜检查。于右腹直肌外缘肋弓下3~4cm作小切口,置入直径5mm套管针作牵引孔。在脐水平左腹直肌外缘左1~2横指处置入直径1cm套管针作主操作孔…     

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38例治疗体会

我院自2006年1月至2011年1月共收治38例胰腺假性囊肿,现就其治疗方法优、缺点探讨如下. 临床资料 1.一般资料:本组38例,男30例,女8例,年龄38～65岁.均经术前B超或CT证实为胰腺假性囊肿.均有胰腺炎发作史,多发囊肿20例,单发囊肿18例,囊肿体积范围3cm×3cm×4cm～8cm×9cm×12cm,合并慢性支气管炎及肺气肿3例,高血压7例,糖尿病5例,心功能不全3例,5例伴有既往腹部手术史,其中3例因重症胰腺炎脓肿探查引流1～2次,1例伴有胆结石手术史,1例阑尾切除史.     

胰腺假性囊肿的腹腔镜处理

胰腺假性囊肿是常见的胰腺囊性损害。急慢性胰腺炎和胰腺损伤是其主要成因。腹腔镜下治疗方式主要包括囊肿内引流术、囊肿外引流术、囊肿切除术。治疗方式的选择与囊肿大小、位置及引起的临床症状密切相关,不同的治疗方案临床治疗效果也不相同。     

胰腺假性囊肿治疗方法的选择

该文报告２３例胰腺假性囊肿,根据病期,囊肿大小,部位选择治疗方法,其中非手术治疗５例,外引流１例,内引流１４例,囊肿切除术３例,结果：无手术死亡,非手术治愈５例,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。我们认为急性囊肿应观察６周,有些周例有自行消散的可能,慢性囊肿一经确诊即可行内引流治疗,内引流是目前较理想的有效手术方式。     

腹腔镜下序贯式外引流和内引流术治疗胰腺假性囊肿一例

患者女，72岁。因进行性腹胀1年入院。1年前曾患急性重症胰腺炎，保守治疗2个月后好转出院。查体：腹部隆起，左上腹可触及巨大包块，无压痛。CT未左上腹巨大囊性肿物。诊断为胰腺假性囊肿。行腹腔镜序贯式外、内引流术。术后6 h进食并下床活动，前5 d每日引流150－200ml液体，以后明显减少，     

假性胰腺囊肿

假性胰腺囊肿孟翔凌（安徽医科大学附院外科合肥２３００２２）胰腺假性囊肿（Ｐｓｅｕｄｏｃｙｓｔｏｆｐａｎｃｒｅａｓ，ＰＰＣ）是发生在胰腺及其附近的一种只有炎性纤维组织而无上皮细胞村里的囊肿。近年来由于医技方面的发展，特别是广泛使用了Ｂ型超声、ＣＴ及ＥＲ...     

胰腺假性囊肿外引流术后胰瘘的酒精灌注治疗

胰腺假性囊肿 (ｐａｎｃｒｅａｔｉｃｐｓｅｕｄｏｃｙｔｅｓ ,ＰＰＣ)是胰腺炎和胰腺创伤的常见并发症 ,据Ｇｕｉｃｅ报道占胰腺疾病的 2 %～ 10 % ,ＰＰＣ急性期经外引流术后往往并发胰瘘 ,治疗困难。我院自 1994年 8月～1999年 10月收治 10例ＰＰＣ外引流术后胰瘘的患者 ,采用经外引流管灌注无水酒精的方法施治 ,取得了良好疗效。现报告如下。临床资料一、一般资料10例中男性 7例 ,女性 3例 ;年龄 2 8～ 6 9岁。病因包括胆源性胰腺炎 4例 ,胰腺外伤 3例 ,酒精性胰腺炎 2例 ,原因不明 1例。病程 2 0ｄ～ 1年。其中发病距手术时间 30ｄ以内…     

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。     

Laparoscopic drainage of pancreatic pseudocysts

Background. Laparoscopic drainage of pancreatic pseudocysts (PPs) has been used in selected cases. The aim of this study is to analyze our results with the laparoscopic technique and to compare them with those of a cohort of patients treated by open surgery during the same time period.Patients and methods. Ten patients underwent laparoscopic drainage of PPs during a 7-year period [laparoscopic group (LG)]. The type of drainage was chosen according to the size and location of the PP. Demography, surgical details, results, and complications were analyzed and contrasted with those of 6 patients who underwent open drainage [open group (OG)].Results. All patients presented with mature PPs developed after a documented episode of acute pancreatitis. Mean age of the LG was 42 years (six males and four females). In the OG, mean age was 36 years (five males and one female). Etiology of the pancreatitis was alcoholic in eight patients, biliary in five, toxic in two, and associated with systemic lupus erythematous in one. Laparoscopic procedures included Roux-en-Y cystojejunostomy in four patients, extraluminal cystogastrostomy in four, and intraluminal cystogastrostomy in two. There were no conversions. In the OG, cystogastrostomy was performed in three patients and Roux-en-Y cystojejunostomy in three. One patient in the LG developed upper gastrointestinal bleeding the day after surgery that resolved uneventfully, one patient presented a postoperative abscess that required open drainage, and one patient presented a residual pseudocyst that was treated by endoscopy. Morbidity in the OG included a small bowel obstruction secondary to an internal hernia that required reoperation, pneumonia, and a residual pseudocyst that was treated conservatively in one patient each. At a median follow-up of 22 months (range, 1–72) all patients were asymptomatic with no evidence of recurrent disease by computed tomography scan.Conclusion. Laparoscopic drainage of PPs is feasible, safe, and effective. Results are similar to those obtained using the open technique.     

假性胰腺囊肿的外科手术治疗

目的对假性胰腺囊肿的外科手术治疗方式和效果进行评价。方法回顾性分析了我院1990年1月至2003年10月68例假性胰腺囊肿行手术治疗的方式、效果及并发症。结果行外科手术治疗的病人人数占同期假性胰腺囊肿治疗病人的48．9％(68／139)。手术方式包括：外引流术9例，死亡率11．1％(1／9)；囊肿胃吻合20例，术后消化道出血的发生率为35％(7／20)，死亡率5％(1／20)；囊肿空肠Roux-en-Y吻合23例，术后消化道出血的发生率为13％(3／23)，死亡率4．3％o(1/23)；假性囊肿切除14例；囊肿十二指肠吻合1例；胰十二指肠切除1例。结论虽然目前假性胰腺囊肿的治疗可有多种选择，但仍有许多病人需要外科手术治疗。手术治疗应尽可能行内引流术，其中囊肿胃吻合术是一种简单合理的内引流术式，应作为首先。对于难以排除恶性的假性囊肿，应尽量手术切除。     

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.     

经皮穿刺引流和手术治疗胰腺假性囊肿40例

目的 观察经皮穿刺引流和手术治疗胰腺假性囊肿的疗效.方法 分析2007 年1 月至2010 年12 月在我院消化科和普外科住院治疗的保守治疗无效的病例资料齐全胰腺假性囊肿患者的所有临床资料.根据治疗方法,分为经皮穿刺引流和外科手术两组.随访3 个月~2 年.结果 40 例患者,男23 例,女17 例,年龄16~65 岁(平均43.1 岁).治疗总有效率100.0%,首次治愈率87.5%.经皮穿刺引流组8 例,首次治愈5 例(治愈率62.5%),余3 例手术治愈;外科手术组32 例,首次治愈30 例(治愈率93.8%),术后复发2 例,1 例再次手术治愈,1 例引流治愈.穿刺引流组和外科手术组疗效比较差异无统计学意义(P>0.05).结论 穿刺引流与手术均是治疗胰腺假性囊肿的可靠疗法,穿刺引流为微创,如不成功再行手术无特殊影响.外科手术疗效好,疗程短,相对穿刺引流创伤较大.     

Endoscopic pancreatic duct drainage and stenting for acute pancreatitis and pancreatic cyst and abscess

Background/Purpose Endoscopic drainage of pancreatic pseudocysts using transpapillary and transmural approaches has been reported. In this study, endoscopic nasopancreatic drainage (ENPD) and pancreatic stenting were performed in patients with pseudocyst and abscess associated with acute pancreatitis, and the usefulness and problems of the procedures were investigated. Methods After endoscopic retrograde pancreatography was done, ENPD and/or pancreatic stenting were performed in 13 patients with pancreatitis and pseudocyst or abscess that communicated with the main pancreatic duct. Results ENPD was performed in seven patients, and was effective in all five patients with cysts: the cysts disappeared or shrank. However, the condition in the two patients with abscess was unchanged, and percutaneous drainage was performed. Stenting was carried out in six patients, and the cyst disappeared or pancreatitis was improved in all six. The stent was removed from two patients, but no recurrence has been noted so far. Conclusions ENPD and stenting are effective therapeutic choices for acute and chronic pancreatitis and pseudocysts, and they are superior to percutaneous drainage to avoid pancreatic fistula, but they may not be effective for pancreatic abscess. Selection of therapeutic methods corresponding to individual cases is important.     

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目的 探讨胰腺假性囊肿(PPC)的治疗方法和其基础疾病的关系。方法 收集浙江大学医学院附属第一医院1992～2003年收治的73例PPC的临床资料，根据D’Egidio分型方法分型，前瞻性分析其基础疾病、主胰管解剖和治疗成功率的相关关系。结果 37例D’EgidioⅠ型PPC中16例进行手术引流，8例发生并发症或复发，治疗成功率为50％(8／16)；另11例行经皮穿刺引流，治疗成功率82％(9／11)。24例Ⅱ型PPC中9例行经皮穿刺或手术外引流，5例发生并发症或复发，治疗成功率为44％(4／9)；另12例经手术内引流或切除治疗，治疗成功率为92％(11／12)，12例Ⅲ型PPC，10例经手术内引流或切除治疗，2例复发，治疗成功率为80％(8／10)。结论 对胰腺假性囊肿基础疾病的分型可以指导其治疗。了解胰腺假性囊肿的基础疾病，对Ⅱ型、Ⅲ型PPC行ERCP明确胰管解剖，有利于正确选择治疗方案，降低并发症发生率和复发率。     

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.     

Laparoscopic treatment of pancreatic pseudocysts

Background A multicentric study was performed to evaluate the clinical results after laparoscopic treatment of pancreatic pseudocysts (PP). Methods We collected the data of 17 patients presenting with PP and operated on by laparoscopy between 1996 and 2001. There were nine men and eight women with a median age of 42 years (range 30–72). In 15 patients the PP developed after acute pancreatitis and the median delay between the acute onset and surgery was 7 months (range: 2–24). In two patients the PP was associated with chronic pancreatitis. All the patients has a single PP with a median diameter of 9 cm (range: 5–20). Results According to the location of the PP, a cystogastrostomy was performed in 10 patients and a cystojejunostomy in seven patients. The median operative time was 100 min (range: 80–300). Laparoscopic PP surgery was completed suscessfully in 16 patients and the median size of the cystoenterostomy was 3 cm (range: 2–5). Necrotic debris was present within the PP in 11 patients. The median, postoperative hospital stay way 6 days (range: 4–24). No mortality and no immediate morbidity were recorded. However, two patients were readmitted within the first 3 postoperative weeks because of secondary PP infection. The first patient had an early closure of cystograstrostomy and was treated by endoscopic placement of a stent. The second represented with a right retrocolic abscess after cystojejunostomy and was treated by percutaneous drainage. One patient was lost for follow-up 2 months after surgery. The others had regular clinical and radiological controls. With a median follow-up of 12 months (range: 6–36), no recurrence of PP was observed. Conclusions The laparoscopic treatment of PP was associated with a low postoperative complication rate and an effective permanent result. That approach avoided some difficulties, particularly bleeding that is classically linked with endoscopic internal drainage.     

外固定支架联合负压封闭引流技术治疗开放性骨盆骨折合并会阴撕裂感染的疗效观察

目的：外固定支架联合负压封闭引流技术治疗开放性骨盆骨折合并会阴撕裂感染的临床疗效。方法回顾性分析本院于2007年1月至2012年12月收治的68例开放性骨盆骨折合并会阴撕裂感染患者的临床资料,将其中32例接受外固定支架联合VSD技术治疗的患者作为VSD组,36例接受传统换药与外固定支架治疗的患者作为对照组。对比分析两组的临床疗效。结果 VSD组患者体温高于正常的时间、创面愈合的时间显著短于对照组患者（t =6.000、6.769,P ＜0.05）,两组患者骨折愈合的时间差异无统计学意义（t =1.276,P ＞0.05）;VSD组患者治疗1周后WBC、N%、ALT、AST和Ccr的水平显著低于对照组（t =8.239、5.474、2.679、3.092、4.697,P ＜0.05）;VSD组与对照组患者骨折愈合后Majeed评分差异无统计学意义（Z =0.524,P ＞0.05）。结论在开放性骨盆骨折合并会阴撕裂感染治疗中,使用外固定支架固定联合VSD技术能够使得患者的感染得到有效的控制,创面与骨折部较好地愈合,值得推广。     

Laparoscopic cystogastrostomy for the treatment of pancreatic pseudocysts in children

Pancreatic pseudocysts (PPSs) are common sequelae of pancreatitis and pancreatic trauma. The management is based upon the pseudocyst size and presence of symptoms. Those requiring intervention are often drained using several available options. The use of laparoscopic cystogastrostomy for large and recurrent PPSs has been described in adult patients as a less morbid alternative to open drainage procedures. This technique is considered a novel approach in children.We describe 2 children who had PPSs amenable to laparoscopic cystogastrostomy. The first was an 11-year-old girl who had blunt abdominal trauma from a bicycle handlebar. The second patient was a 7-year-old girl who developed idiopathic pancreatitis. Briefly, 2 ports were placed through the anterior abdominal and gastric walls, and into the lumen of the stomach. This intraluminal placement provided access to the posterior gastric wall. Using electrocautery diathermy, an incision was made through the posterior gastric wall and into the adjacent pseudocyst to obtain complete and unobstructed drainage. Both children tolerated the procedures well with resolution of their PPSs. The patients were each discharged on the fourth postoperative day and have been asymptomatic on 2 years follow-up.Laparoscopic cystogastrostomy is a safe and effective alternative to open cystogastrostomy for the minimally invasive management of PPSs in the pediatric population.