胰腺假性囊肿的外科治疗：附31例报告

回顾性分析我院1997-2006年收治的胰腺假性囊肿31例的外科临床资料。全组5例行保守治疗，2例囊肿明显缩小，3例囊肿消失。26例行手术治疗，其中6例行外引流，17例行内引流，3例行胰腺囊肿及胰体尾部联合切除，无手术死亡。提示：对胰腺假性囊肿的外科治疗，应根据发病机制、病程、囊肿位置、大小及是否有合并症而决定个体化治疗方案；合理的治疗是决定预后的关键。     

胰腺假性囊肿的治疗：附35例报告

回顾分析35例胰腺假性囊肿患者的临床资料。非手术治疗6例，6例经皮导管引流，23例开腹手术治疗,疗效满意。提示:胰腺假性囊肿的治疗,应根据囊肿形成的时间、囊肿的大小、 囊肿的不同部位、患者能否耐受手术以及有无合并症等因素,采用不同的治疗方法。     

胰腺假性囊肿的外科治疗体会

回顾性分析5年余收治的25例胰腺假性囊肿的病例资料。行囊肿空肠吻合术7例，囊肿胃吻合术1例，单纯囊肿外引流术9例，内引流+外引流术2例，外引流+脾切除术1例，外引流+半胃切除+胃空肠吻合术1例，囊肿切除术1例，经皮穿刺置管引流术1例，非手术治疗2例。外引流术后1例因胰瘘而再行瘘管空肠吻合术，1例因胰瘘而再行瘘管切除术，1例囊肿胃吻合术后并发消化道出血经非手术治疗而愈，其余病例术后均痊愈。提示胰腺假性囊肿应根据不同情况选择不同的治疗方式，大多能治愈。     

巨大胰腺假性囊肿外科内引流术式的选择

目的探讨巨大胰腺假性囊肿内引流术治疗的术式选择。方法回顾性分析收治且行囊肿内引流的13例巨大胰腺假性囊肿(长径15 cm)的临床资料。结果均经B超或/和CT以及术后病理学检查明确胰腺假性囊肿的诊断。行囊肿空肠Roux-en-Y型吻合术的6例,其中术后囊肿感染2例。囊肿胃吻合术3例,术后囊肿感染2例,消化道出血1例,其中2例需二次干预。囊肿胃肠道一期内、外引流术4例,其中囊肿胃一期内、外引流术2例,术后1例囊肿感染,非手术治疗后痊愈;囊肿空肠Roux-en-Y一期内、外引流术2例,无术后并发症。全组无死亡病例。结论对部分巨大胰腺假性囊肿,囊肿胃肠道一期内、外引流术可能更为合适。对适宜行囊肿胃吻合术的巨大胰腺假性囊肿,建议行囊肿胃一期内、外引流术。     

对胰腺炎后胰腺假性囊肿外科处理的重新认识

重新认识胰腺炎后胰腺假性囊肿的外科处理,探讨内引流术治疗囊肿伴感染及坏死的可能性。方法：回顾性分析１９８８年－１９９６年我科收治的２５例胰腺炎后胰腺假性囊肿患者。结果;手术治疗的２２例中,对６例高度怀疑感染的囊液作了细菌培养,证实例继发感染。１８例行内引流,包括４例囊液呈腔样者,均无并发症,随访１－９年无复发。外引流仅３例,明显低于国内文献报道的平均值２１．７％。结论：根据囊肿内容物性状来判断是否     

外伤性胰腺假性囊肿的手术指征及选择：附11例报告

目的探讨外伤性胰腺假性囊肿的手术指征。方法回顾性分析2003年1月—2008年3月收治的11例外伤性胰腺假性囊肿的临床资料。结果 11例患者中2例合并胰管断裂者先行外引流后行内引流治疗,4例行内引流治疗,余5例未行手术治疗,所有患者均治疗成功。结论外伤性胰腺假性囊肿由于胰腺损伤程度及胰腺炎症程度的不同,治疗方法应相应变化,需根据有无胰管断裂及胰腺坏死决定治疗方案。     

胰腺损伤14例临床分析

回顾性分析14例胰腺损伤的诊断、治疗及并发症。结果示非手术治疗胰腺损伤其所形成胰腺假性囊肿远多于手术治疗者，非手术治疗适应证为胰腺轻度损伤而胰管无损伤者。结果提示，手术治疗胰腺损伤有利于防治并发症，尤其假性囊肿。应根据剖腹探查正确判定胰腺损伤的部位，程度和范围来选择合理的手术方式。     

胰腺假性囊肿的诊断与治疗:附36例报告

对 36例胰腺假性囊肿的临床资料进行了回顾性分析。全组 2例经非手术治疗治愈 ;行B超引导下囊肿穿刺置管引流 3例 ,其中 1例复发 ,1例因衰竭死亡行外引流 6例 ,2例形成胰瘘 ,经二次手术治愈 ;行内引流术 2 2例 ,均治愈 ;行囊肿胰尾切除 3例 ,均治愈 ,无复发及癌变。提示胰腺假性囊肿绝大部分因急、慢性胰腺炎或胰腺外伤所致 ,早期可非手术治疗 ,除非出现囊肿感染、出血、破裂或不能耐受手术而行穿刺置管引流或外引流术 ,否则均应行内引流术。内引流术效果最佳。     

胰腺囊性疾病破裂的诊断与治疗(附20例临床病例分析)

目的探讨胰腺囊性疾病破裂的诊断与治疗。方法回顾性分析2011年6月至2015年12月期间哈尔滨医科大学附属第一医院胰胆外科收治的20例胰腺囊性疾病破裂患者的临床资料,其中胰腺假性囊肿15例,胰腺囊性肿瘤5例。结果 5例胰腺囊性肿瘤患者均行手术切除,其中2例行胰十二指肠切除术,3例行胰体尾脾切除术。15例胰腺假性囊肿患者中,行超声引导下胰腺假性囊肿穿刺置管引流2例;内镜下胰管内支架引流2例;内镜下胰管内支架引流联合超声引导下胰腺假性囊肿穿刺置管引流2例;手术治疗9例,其中假性囊肿外引流1例,假性囊肿内引流8例(胰腺假性囊肿空肠吻合5例,胰腺假性囊肿胃吻合3例)。术后发生胰瘘3例(A级2例,B级1例),胃排空障碍1例,肺部感染2例,腹腔积液1例。随访3个月至5年,平均25.6个月,1例胰腺假性囊肿患者行内镜下胰管内支架引流术后假性囊肿复发,还有1例胰腺假性囊肿患者行假性囊肿内引流术后复发,2例复发患者均经非手术治疗后症状好转,痊愈出院。结论正确地鉴别胰腺囊性肿瘤与胰腺假性囊肿是胰腺囊性疾病破裂治疗方式选择的前提。胰腺囊性疾病破裂的治疗较常规胰腺囊性疾病的治疗急迫,治疗方式的选择至关重要,应根据患者具体情况制定出个体化治疗方案,使患者最大程度获益。     

闭合性胰腺损伤的诊断和治疗：附32例报告

目的：探讨闭合性胰腺损伤的早期诊断和治疗方法。
方法：回顾性分析收治的闭合性胰腺损伤32例的临床资料。
结果：CT诊断符合率为79.3%。非手术治疗4例,其中I级3例,II级1例。 手术治疗28例,I级5例和II级7例行胰周清创外引流术;6例Ⅲ级胰腺损伤中,行远端胰腺切除术和脾切除术4例,行保脾远端胰腺切除术2例;5例Ⅳ级胰腺损伤中,行胰腺空肠Roux-en-Y吻合术4例,行远端胰腺切除术和脾切除术1例;5例Ⅴ级胰腺损伤中,行十二指肠憩室化手术1例,2例胰头严重毁损伤行胰十二指肠切除术,2例由于复合伤情较重,首先应用损伤控制手术,于受伤后48 h再次行彻底性手术。全组死亡3例,死亡原因主要为多器官功能衰竭,余25例中术后发生并发症19例（76.0%）,包括胰瘘、胰腺假性囊肿等,均经治疗而愈。
结论：无明确主胰管损伤、临床情况稳定时,胰腺损伤可先行非手术治疗。手术治疗适于重度闭合性胰腺损伤,根据胰腺损伤的程度选择合理的手术方式可提高治愈率,降低病死率。     

胰腺假性囊肿诊治体会

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。     

Surgical management of pancreatic pseudocyst.

BACKGROUND: Pancreatic pseudocysts were once considered to be an unusual complication of acute chronic and traumatic pancreatitis. METHODS: This work was made in order to study the results of the operative methods in 24 patients with acute chronic and traumatic pancreatic pseudocysts, treated by external or internal drainage during the years 1990-1995 at the Athens Red Cross Hospital and compare these results with those of international literature. Pain was the common symptom for all patients. Gallstones were the most important aetiological agent in thirteen of the 24 patients, while alcoholic pancreatitis was diagnosed in only 6 of them. Fifteen patients (62.5%) were treated by surgical drainage or resection and 9 patients (37.5%) were treated by observation, one by percutaneous and one by endoscopic drainage. The rest had small cysts (less than 5 cm) and were treated by observation. RESULTS: The most frequent complication of internal cyst drainage was upper gastrointestinal haemorrhage. The rate of mortality was 7%. CONCLUSIONS: Anatomical considerations dictate the choice of operation. Cystogastrostomy, for example is inappropriate unless the stomach is closely applied to the front of the cyst. We preferred cystojejunostomy Rouen-y because the Roux loop can be anastomosed to the lower part of the cyst. Cystoduodenostomy should be reserved for pseudocyst in the head of the pancreas. Resection is an alternative to internal drainage for chronic pseudocyst of moderate proportions, for those that have largely replaced a portion of the pancreas.     

胰腺囊性病变90例临床分析

目的总结胰腺囊性病变的临床特点,探讨胰腺囊性病变的诊断和治疗方法。方法回顾性分析90例胰腺囊性病变患者的临床资料。结果 90例胰腺囊性病变中,假性囊肿69例,囊性肿瘤21例(囊腺癌11例,囊腺瘤6例,乳头状管状腺癌4例);40例行保守治疗,3例经皮穿刺外引流,8例经超声内镜引流,39例手术治疗(外引流术1例,内引流术22例,囊肿及胰体尾切除14例,胰头切除2例)。结论 CT和EUS对囊性病变的诊断具有重要价值,不同的囊性病变选择不同的治疗方式,以降低复发率、减少并发症。     

Management of pancreatic pseudocysts

BACKGROUND: This review analyses the outcome for patients with acute and chronic pancreatic pseudocysts managed in two major referral centres. PATIENTS AND METHODS: From 1987 to 1997, 33 patients were treated with either acute (n = 19) or chronic (n = 14) pseudocysts. Procedures performed included cystgastrostomy (64%), cystduodenostomy (6%), cystjejunostomy (3%), distal pancreatectomy with resection of pseudocyst (12%), laparotomy with external drainage (9%), endoscopic transpapillary stenting (3%) and endoscopic pancreatic duct sphincterotomy with percutaneous drainage of the pseudocyst (3%). RESULTS: All patients had resolution of their pseudocyst and no patient developed recurrence. There were no deaths in this series. There was a 9% incidence of major complications and a 21% incidence of minor complications. Outcome was excellent in 63% and good in 27% of patients. Two patients (6%) had persistent chronic pain and one patient (3%) had evidence of exocrine pancreatic insufficiency with malabsorption. CONCLUSIONS: Surgical internal drainage of pancreatic pseudocysts can be performed safely with low morbidity and mortality provided patients are carefully selected and their medical management is optimized. Although minimally invasive techniques now offer a variety of treatment options, open surgical drainage is still indicated for a significant number of cases.     

Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst.

The records of 92 patients with symptomatic pancreatic pseudocysts referred for surgical management over a 27-year period were retrospectively reviewed to compare outcome in 42 patients managed with operative internal drainage procedures (group I) with that in 52 patients managed with computed tomography-directed percutaneous catheter drainage (PCD) (group II). The two groups were similar for patient age, sex, pseudocyst location, and cause. The frequency of antecedent pseudocyst-associated complications was less in group I (16.7 versus 38.5%, p less than 0.05). Seven group I patients and four group II patients had major complications (16.7 versus 7.7%, not significant). Group II mean duration of catheter drainage was 42.1 days, and the drain track infection rate was 48.1%. The frequency of antecedent operative cyst drainage was similar (14.2 versus 13.5%), as was the frequency of subsequent operations for complications related to chronic pancreatitis (9.5 versus 19.2%, not significant). Mortality rate was greater in group I (7.1% versus 0%, p less than 0.05). Pseudocysts can be effectively managed either by open operation with internal drainage or by PCD. Drawbacks of PCD include the controlled external pancreatic fistula and the risk of drain track infection. Percutaneous catheter drainage has the following advantages: (1) low mortality rate, (2) does not require a major operation, (3) does not violate the operative field in cases when subsequent retrograde duct drainage procedures are required. Neither PCD nor internal drainage is definitive, and with either technique subsequent correction of underlying pancreatic pathology may be necessary.     

Laparoscopic endogastric pseudocyst gastrostomy: a report of three cases

The transgastric pseudocyst-gastrostomy is the standard approach for internal drainage of persistent and large retrogastric pancreatic pseudocysts that complicate acute necrotizing pancreatitis. We report on the application of a laparoscopic endogastric approach for drainage of pancreatic pseudocysts and discuss the merits of this technique as well as of the other previously described minimally invasive approaches for the management of pancreatic pseudocysts. Between January 2001 and August 2001, three female patients presented with large symptomatic pseudocysts 3-10 months after an episode of acute necrotizing pancreatitis. Internal drainage was effected by a laparoscopic endogastric pseudocyst gastrostomy, and the necrotic pancreas was debrided. There were no conversions and no postoperative complications. The median postoperative hospital stay was 4 days (range, 3-5). All patients remain asymptomatic, and resolution of the pseudocyst was radiologically evident at a median follow-up of 6 months (range, 4-11). The laparoscopic endogastric pseudocyst gastrostomy appears to be a safe and effective minimally invasive approach for internal drainage of large retrogastric pancreatic pseudocysts and facilitates debridement of the necrotic pancreas.     

Multiple pancreatic pseudocyst disease.

In an effort to determine the incidence of multiple pseudocyst disease and establish the optimal approach to this problem, the records of 91 consecutive patients diagnosed during a 36-month period as having pancreatic pseudocyst disease by sonography or computerized tomographic scanning were reviewed. Thirteen patients (14.3%) had multiple cysts; all received sonograms and six had CT scans. The combined false negative and false positive rate with sonography was 9%. Spontaneous resolution occurred involving five cysts (18%) up to 6.5 cm in size. The diagnosis of cyst multiplicity was confirmed at operation in seven cases; two of the seven operations were excisional and the remaining patients received drainage procedures. There were no operative deaths; complications included one patient who required chronic enzyme replacement therapy after excision and another patient who developed a subphrenic abscess after attempted percutaneous drainage. The incidence of multiple pseudocyst disease in our series is just over 14%. The possibility of multiplicity should be carefully investigated in each patient with pseudocyst disease. In light of the rate of spontaneous resolution, not all patients with multiple pseudocysts may require operative therapy. Because of the 7.7% false negative diagnoses with sonography, CT scanning is especially helpful when the diagnosis of multiple pseudocysts is suspected or in preoperative preparation of pseudocyst drainage. If an operation becomes necessary, a drainage procedure rather than excision should be used whenever possible to maximize gland salvage.     

非胰腺手术后胰腺假性囊肿的治疗

目的探讨非胰腺手术后胰腺假性囊肿的治疗方法。方法对近11年来治疗的28例非胰腺手术后胰腺假性囊肿进行回顾性临床分析。结果保守治疗4例。B超引导下经皮多次穿刺10例(其中穿刺后置管外引流3例)。手术行外引流6例,内引流8例。1例外引流无效后,改行内引流。28例均痊愈出院。结论手术后胰腺假性囊肿应采用个体化的治疗原则,早期应采取保守治疗、穿刺抽液或外引流,内引流可作为治疗的最后选择。     

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。     

Changing concepts in the surgical management of pancreatic pseudocysts.

A 27-year experience in the surgical management of 160 patients with pancreatic pseudocysts was reviewed. Sixty-eight patients treated from 1964 to 1981 (Group I) were compared to 92 patients managed from 1982 to 1990 (Group II). During the recent period, computed tomography (CT) scanning, endoscopic retrograde cholangiopancreatography (ERCP), selective visceral angiography, and percutaneous catheter drainage (PCD) techniques were available. The mean age of patients was similar in both groups (45 vs 44 years). Most pseudocysts in both periods represented complications of chronic pancreatitis due to alcohol abuse (82% vs 87%). Pancreatitis-associated complications occurring before management (fistula, obstruction, hemorrhage) were more frequent in Group II (19% vs 40%, P less than .05). There was a significant increase in the number of patients managed with external drainage in Group II (10% vs 52%) attributable to the use of PCD as definitive therapy in 46 per cent of patients in the recent period. Use of internal drainage procedures (cystgastrostomy, cystduodenostomy, cystjejunostomy) decreased in Group II (38% vs 16%, P less than .05). The use of lateral pancreaticojejunostomy (LPJ) combined either with caudal resection or cyst drainage has remained constant in both periods (32% vs 24%, NS). Patient morbidity was similar (26% vs 28%, NS) and mortality improved in Group II (9% vs 1%, P less than .05). Internal or external drainage for pseudocyst is often not definitive because of the underlying ductal disease. The authors' current approach is to manage large symptomatic cysts either with internal drainage or PCD; they employ octreotide acetate in the management of persistent pancreatic fistula following external drainage.(ABSTRACT TRUNCATED AT 250 WORDS)