胰腺假性囊肿48例报告

目的 总结胰腺假性囊肿的治疗经验.方法 回顾性分析2000年1月至2012年12月收治的48例胰腺假性囊肿的临床资料.结果 非手术治疗8例,在随访期间均能自行吸收;手术治疗40例:包括胰腺假性囊肿胃吻合11例,术后有1例出现吻合口出血;囊肿十二指肠吻合1例;囊肿空肠Roux-en-Y吻合23例,术后有2例出现吻合口出血;胰腺假性囊肿外引流术3例,术后有1例出现胰瘘;胰腺假性囊肿切除术2例,术后有1例出现胰瘘.结论 胰腺假性囊肿的治疗方法已趋于多样化,应根据患者的具体病情来选择适宜的治疗方式;手术治疗中囊肿内引流术仍是主要术式,根据囊肿的具体情况选择不同的吻合方式.     

腹腔镜胃前壁切开入路假性囊肿-胃吻合术治疗胰腺假性囊肿的体会

目的 探讨腹腔镜胃前壁切开入路假性囊肿-胃吻合术治疗胰腺假性囊肿中的应用和效果。方法 回顾性分析2016 年12 月至2019 年6 月浙江省人民医院肝胆胰外科/微创外科（3 例）、安吉县第三人民医院外科（1 例）、永康市第一人民医院外一科（1 例）共5 例胰腺假性囊肿行腹腔镜下胃前壁切开入路胰胃吻合术治疗的临床资料,分析该术式的近远期疗效。结果 5例胰腺假性囊肿患者,其中男4例,女1例,2 例为胰腺术后胰漏所致假性囊肿,2 例为急性胰腺炎所致假性囊肿,1 例为胰腺外伤后所致假性囊肿。手术时间60～150 min,术中出血10～50 mL,术后无胰漏、胃漏、消化道出血等。术后随访2～24 个月,无反复发作胰腺炎、囊肿腔内感染及囊肿复发。结论 腹腔镜胃前壁切开入路囊肿-胃吻合治疗胰腺假性囊肿操作简单、安全有效,在合适病例中值得推荐。     

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。     

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。     

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。     

腹腔镜下外引流术治疗胰腺假性囊肿合并感染

【摘要】 目的 探讨腹腔镜下外引流术治疗胰腺假性囊肿合并感染的安全性和可行性。方法 回顾分析2006年1月至2013年2月在我院肝胆胰外科接受腹腔镜下感染性胰腺假性囊肿外引流术的病例资料共20例(男性15例,女性5例)。结果 全组病人平均手术时间为46.3 min,平均住院时间11.2 d。术后出现胰液外渗并腹腔感染1例、胰瘘形成3例、肺部感染2例。所有病人术后均康复出院。胰腺假性囊肿引流管放置时间平均45.5 d(36~92),拔管后有3例胰腺假性囊肿复发,需行胰腺假性囊肿内引流术。结论 腹腔镜下外引流术治疗胰腺假性囊肿合并感染是一种安全可行、创伤小的手术方式。     

腹腔镜胰腺假性囊肿内引流及胰腺远端切除的初步体会

目的探讨腹腔镜下胰腺假性囊肿-胃内引流术和保留脾脏胰腺远端切除术(Kimura法)的可行性和安全性。方法总结完全腹腔镜下1例胰腺假性囊肿-胃内引流术和4例保留脾脏胰腺远端切除术(Kimura法)的治疗体会。结果胰腺假性囊肿-胃内引流手术时间150 min,出血量150 ml。术后胰腺假性囊肿明显缩小,脾静脉受压明显缓解。4例胰腺远端切除平均手术时间245 min,平均出血量180 ml,平均住院时间7.8 d。1例胰腺远端切除患者术后1个月复查时发现胰腺断端旁有假性囊肿形成,直径约3 cm,观察6个月后囊肿无变化。5例患者中位随访时间8.2月,胰腺假性囊肿及肿瘤均无复发。结论腹腔镜下胰腺假性囊肿-胃内引流术和保留脾脏胰腺远端切除术(Kimura法)是安全可行的,具有创伤小、术后恢复快等优点,但适应症的选择至关重要。     

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。     

动脉内插管栓塞控制胰假性囊肿大出血

胰腺炎所致的大出血比较罕见,据文献报告为1.7～7.5%.本病非手术治疗的死亡率很高,必须及早作出诊断和采取适当的外科治疗.出血可来自邻近胰假性囊肿的脏器血管,可以成功地手术治疗,但在出血的炎性组织内施行手术相当困难.本文报告4例经动脉内插管栓塞控制出血的经验.病例1:39岁男性,因胰头部假性囊肿行胃囊肿内引流术.术后一周内有几次黑便,在术后11天突然大量呕血,动脉造影显示胃十二指肠动脉假性动脉瘤出血,经胃囊肿吻合口流入胃内.动脉内用明胶海绵检塞治疗成功,少量明胶海绵也进入肝动脉内,但未引起不良后果,以后未再出血.2月后重复动脉造影,未见动脉瘤复发.病例2:49岁男性,已知有酒精性胰腺炎和假性囊肿,出现十二指肠和胆道梗阻以及一次呕血.手术     

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。     

胰腺巨大假性囊肿27例的外科治疗

目的 探讨巨大胰腺假性囊肿的临床特点,并对各种外科治疗方法进行评价.方法 对1991年2月至2008年2月收治的27例巨大胰腺假性囊肿(长径>10cm)的临床资料进行回顾性分析.结果 27例巨大胰腺假性囊肿约占同期全部胰腺假性囊肿的20.9%;病因分类:急性胰腺炎所致占51.9%,胰腺外伤和手术所致占33.3%,慢性胰腺炎所致占11.1%;病程小于6周者占绝大多数(21/27);30%患者出现上消化道梗阻(8/27);影像学上虽然囊肿巨大,但均为单房囊肿;ERCP检查发现多数囊肿与胰管相通(9/11).手术方式包括囊肿外引流术9例,均失败,改行其他内引流术.囊肿胃吻合术10例,1例失败,改行囊肿空肠引流术,ERCP胰腺导管囊肿内支架引流术2例,1例失败,改行囊肿空肠引流术,囊肿空肠Roux-en-Y吻合术17例(其中11例为采用其他手术方式治疗失败者).所有患者均临床治愈.结论 胰腺巨大假性囊肿多数出现胰管解剖学改变,外科治疗时机和适应证有别于一般性胰腺假性囊肿.     

Endoscopic transmural and transpapillar procedures for the treatment of chronic pancreatitis

93 patients with chronic pancreatitis were treated endoscopically: 44 had transpapillar procedures and 49 patients had transmural operations. The transmural procedures were applied in case of pancreatic pseudicysts, whereas transpapillar endoscopic operations were applied in cases of the obstructive jaundice, pseudocyst, connected of the main pancreatic duct, virsungolithyasis or ductal pancreatitis with pain syndrome. The endoscopic procedures by chronic pancreatitis proved to be the reliable alternative to the traditional surgery.     

胰腺假性囊肿的治疗研究

目的评价胰腺假性囊肿不同治疗方式的效果。方法对1990年1月至2003年4月收治的128例胰腺假性囊肿不同处理方式的效果及并发症进行回顾性分析。结果128例患者中30例未行手术治疗,其中3例失访,27例在随访期间囊肿自行吸收。B超引导下经皮置管引流组22例,有效率60%。外科手术治疗76例,死亡率5.3%(4/76),手术方式包括:外引流10例,死亡率20%(2/10);囊肿胃吻合术14例,术后消化道出血的发生率为42.9%(6/14),死亡率7.1%(1/14);囊肿空肠Roux-en-Y吻合术28例,术后消化道出血的发生率10.7%(3/28),死亡率0%;囊肿十二指肠吻合术3例,死亡率33.3%(1/3);假性囊肿切除术21例。结论B超引导下经皮置管引流创伤小,操作相对简单,但尚未能完全取代传统手术。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。对于怀疑为真性囊肿或囊腺癌者,应尽量手术切除。     

慢性胰腺炎的手术适应证和术式选择

目的提高慢性胰腺炎的外科治疗效果. 方法回顾性总结分析55例慢性胰腺炎外科治疗资料.发病因素:嗜酒5年以上、胆系结石、急性胰腺炎病史分别占38.2%,29.1%和20.0%.主要临床表现:慢性腹痛、梗阻性黄疸、体重减轻、消化不良、糖尿病分别为98.2%,38.2%,34.5%,20.0%和10.9%.全组均因慢性腹痛或伴有胰管和(/或)胆管梗阻、结石、胰腺钙化、肿块、假性囊肿等行外科治疗,共采用了10种术式. 结果无手术死亡和严重并发症.术后效果良好43例(78.2%),症状减轻好转10例(18.2%),无效2例(3.6%). 结论慢性胰腺炎长期慢性腹痛并胰胆管梗阻、结石、肿块、假性囊肿适于外科治疗,应根据病变类型和特点选择不同的术式.胰管梗阻扩张、结石或假性囊肿宜行胰管或囊肿空肠吻合,胰头肿块并胆、胰管梗阻可行胰头十二指肠切除或胆胰管空肠吻合术.     

Assessment of the degree of maturity in the wall of pancreatic pseudocysts in relation to choice of surgical procedure

The aim of this study is to present our experience in the diagnosis and treatment of pancreatic pseudocysts. A pancreatic pseudocyst is an incapsulated collection of pancreatic juice, enclosed by nonepithelial elements, containing a high concentration of pancreatic enzymes, bicarbonates and necrotic detritus. It is a common complication of acute pancreatitis and trauma of the pancreas. In the period between 1996 and 2001, 53 surgical procedures were performed for pancreatic pseudocyst at the Institute for Digestive Diseases (First Surgical University Hospital), 35 male patients (67%) and 17 female patients (33%) underwent surgery. In 39 (75%) patients the method of choice was cystojejunostomy by Roux. In 4 cases distal pancreatectomy for pseudocysts localized within the pancreatic tail was performed, complete pseudocyst excision only was performed in one case and complete pseudocyst excision combined with cystojejunostomy was also performed in one case. Cystogastrostomy and drainage in one case and partial cystectomy and drainage also in one case. Surgical internal drainage is the method of choice for the treatment of pancreatic pseudocysts, involving low morbidity and mortality rates.     

A new diagnostic approach to pancreatic pseudocyst fine-needle puncture: three-dimensional sonography

Background/Purpose We evaluated the usefulness of three-dimensional (3D) sonography in percutaneous fine-needle pancreatic pseudocyst puncture.Methods We examined 52 patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional (2D) ultrasonography findings. The decision to qualify certain patients for percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of 2D and 3D scan results. Spiral computed tomography was done when the presence of connections between pseudocyst and pancreatic duct was suspected. In these cases diagnosis was confirmed in operative procedures. 3D sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection.Results Pancreatic pseudocysts were diagnosed in all 52 cases; 48 patients underwent percutaneous fine-needle biopsies.Conclusions 3D presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical 2D ultrasound scans. The use of subtraction in 3D scans of blood vessels increases the safety in performing biopsies. We have shown that 3D sonography collects extremely useful information about the status of the pseudocyst structure, and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis should help us change the inclusion criteria for guided biopsies.     

胰腺假性囊肿内引流术式的研究

目的：探讨胰腺假性囊肿内引流术的术式选择。
方法：回顾性分析13余年收治且行囊肿内引流治疗的胰腺假性囊肿62例的临床资料,着重探讨手术方法以及效果。
结果：全组均经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31例,术后囊肿感染发生率为9.7%（3/31）,消化道出血发生率为3.2%（1/31）,无死亡病例。行囊肿胃吻合术的16例,术后囊肿感染发生率为12.5%（2/16）,消化道出血发生率为37.5%（6/16）,病死率为6.25%（1/16）。行序贯式囊肿外、内引流术的15例,术后囊肿感染发生率为6.7%（1/15）,消化道出血发生率为13.3%（2/15）,无死亡者。
结论：囊肿空肠Roux-en-Y型吻合术是安全有效的术式;对适宜行囊肿胃吻合术的囊肿,建议行序贯式囊肿外、内引流术。     

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.     

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.     

Presentation of pancreatic pseudocysts: Implications for timing of surgical intervention

A review of 115 patients with pancreatic pseudocysts treated surgically between 1976 and 1984 showed four patterns of presentation: pseudocyst alone, pseudocyst and acute pancreatitis, acute pancreatitis alone, or neither apparent on hospital admission. These patterns of presentation were associated with differences in the clinical course and ultimate surgical outcome of each group of patients. Emergency procedures greatly increased the morbidity and mortality of surgery for pseudocysts. A preoperative delay for pseudocyst maturation was expected to decrease the morbidity and mortality of elective pseudocyst drainage, but no benefit was found either for the series as a whole or for any subgroup. We conclude that an arbitrary preoperative delay for pseudocyst maturation (in the absence of acute pancreatitis) exposes patients to the risks of preoperative complications, increases the expense of care for pancreatic pseudocysts, and fails to improve surgical outcome.