超声内镜引导下胰腺假性囊肿引流术的临床疗效分析

目的 评价超声内镜(EUS)引导下胰腺假性囊肿(PPC)引流术的安全性和有效性.方法 17例PPC患者行EUS以探查和确定适当的穿刺点及穿刺深度,经内镜活检孔将穿刺针刺入PPC腔内,用注射器抽出囊液,X线引导下沿针孔插入导丝,沿导丝置入针状刀以切开胃壁和囊壁,行球囊扩张,根据囊液性状选择引流方式.评价操作成功率、治疗成功率、并发症发生率和操作技巧.结果 4例行鼻囊肿管外引流,9例行双猪尾支架内引流,4例行鼻囊肿管和双猪尾支架联合引流,其治疗成功率分别为3/4、7/9、4/4.1例患者于支架放置成功后见穿刺部位渗血,因内镜下治疗等措施无效而转行外科手术缝扎止血.4例患者在PPC引流过程中出现感染,其中2例因内科治疗效果不佳转行外科手术切除,另2例经静脉滴注囊液细菌敏感抗生素和经鼻囊肿管甲硝唑溶液冲洗PPC处理后痊愈.中位随访时间为28.5个月,无1例复发.结论 EUS引导下PPC引流术安全有效,支架和鼻囊肿管引流对PPC治疗具有重要价值.     

B超引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿42例

[目的]探讨B超引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿的临床意义。[方法]回顾性分析采用B超介导下经皮肝穿刺置管引流治疗肝脓肿42例患者的临床资料,其中单发脓肿38例,2个以上多发脓肿4例。脓肿部位:肝右叶32例,左叶7例,左右肝叶3例。[结果]患者在置管后平均5 d体温恢复正常,引流量逐渐减少和消失,B超检查证实脓腔萎陷及无脓液。从置管到拔管时间为5～16 d,平均(9.6±2.3)d。42例患者经皮肝穿刺置管引流术治疗后痊愈41例,治愈率97.6%。[结论]B超引导下经皮肝穿刺置管引流在细菌性肝脓肿治疗中具有疗效确切,创伤小,恢复快的忧点,是肝脓肿的首选治疗方法。     

中心静脉导管置管引流治疗心包积液38例

目的观察应用中心静脉导管置管引流治疗心包积液的安全性、可行性.方法 38例心包积液病人均应用Seldinger法从剑突下穿刺,将单腔中心静脉导管置入心包腔引流.结果 38例均穿刺成功,引流管留置时间3 d～21 d,平均5.7 d,引流积液量300 mL～3 200 mL,平均634 mL,无明显并发症.结论中心静脉导管经皮穿刺置管引流可用于治疗心包积液.     

CT导向下囊内注射无水乙醇治疗肝囊肿效果观察

目的评价CT导向下经皮穿刺注射无水乙醇治疗肝囊肿的临床应用价值。方法 19例23个肝囊肿,其中单纯性肝囊肿15例,多发性肝囊肿4例。在CT导向下行穿刺无水乙醇硬化治疗,分析其并发症,并追踪观察其疗效。结果 19例中23个囊肿顺利完成穿刺硬化治疗,无并发症发生。对23个囊肿术后追踪观察6～12个月,CT复查囊腔缩小50%以上2例,70%以上9例,囊腔闭合无复发8例。结论 CT导向下经囊内注射无水乙醇治疗是一种安全有效的治疗方法。     

超声引导下穿刺置管治疗肝脓肿的临床效果回顾分析

目的 回顾分析介入置管引流治疗肝脓肿的效果及注意事项。 方法 以我院超声科自 2015 年 9 月至2019 年 9 月采用经皮穿刺置管治疗肝脓肿 49 例为研究对象,脓腔均经穿刺置管引流、并行脓腔冲洗、注药治疗、并根据药敏试验进行抗感染治疗。 结果 本研究 49 例患者均穿刺成功。 术后白细胞和中性粒细胞百分比均较术前明显减低(P 均<0. 05)。 术后及出院时 49 例患者脓肿直径明显小于术前,差异均有统计学意义( P均<0. 05);术后 25例患者体温 3 d 内恢复正常,16 例患者体温 3~ 7 d 内恢复正常,8 例患者体温超过 7 d 恢复正常。 患者均能较好耐受穿刺置管治疗,置管引流时间为 3~ 28 d,平均 13. 5 d,术中及术后未出现胆漏、感染及气胸等并发症,且均无复发迹象。 结论 超声引导下经皮穿刺置管引流治疗肝脓肿已逐渐取代大剂量药物治疗或手术治疗,且临床疗效可靠、并发症少,在临床治疗肝脓肿方法中优势明显。     

CT引导下经皮穿刺置管引流术治疗心包积液的临床价值分析

目的探讨在CT引导下经皮穿刺置管引流术治疗心包积液的临床价值。方法我院选取2013年5月-2015年5月来治疗的28例心包积液患者实施研究,在CT引导下实施经皮穿刺置管引流术治疗,观察术后治疗情况、并发症。结果 28例心包积液患者均一次置管成功,置管成功率为100%。无心包反应、心律失常、脏器损伤等并发症。所有患者经引流治疗后病情均得到缓解或者减轻,平均引流量为(1428.28±167.17)ml;平均置管时间为(8.19±1.18)d。1例患者经引流后再次出现胸痛,及时拔管干预后胸痛症状消失。2例患者引流过程中出现引流不畅导管堵塞症状,经生理盐水冲洗后恢复畅通。结论对心包积液患者在CT引导下经皮穿刺置管引流术治疗安全有效,并且临床治疗中并发症较少,可推广使用。     

无水乙醇置换灌洗配合高渗葡萄糖硬化治疗单纯性肾囊肿

目的探讨CT引导下无水乙醇置换灌洗配合高渗葡萄糖硬化治疗单纯性肾囊肿的疗效及安全性。方法将单纯性肾囊肿患者100例(110个囊肿4 cm)随机分成置换灌洗组和对照组。置换灌洗组患者(50例,56个囊肿)在CT引导定位下经皮常规穿刺成功后,抽出囊液,行无水乙醇反复多次冲洗,再视囊肿大小注入20~50 mL环丙沙星保留20 min后抽出,最后于囊腔内注入50%葡萄糖注射液(注入量为抽出囊液量的20%)。对照组患者(50例,54个囊肿)用传统治疗方法,抽尽囊腔液体,注入抽出囊液量25%的无水乙醇行硬化治疗。术后4个月复查CT比较治疗效果。结果置换灌洗组及对照组患者治愈率分别为53.6%和27.8%,治疗总有效率分别为96.4%和88.2%,复发率分别为3.6%和11.1%。置换灌洗组患者治愈率高于对照组患者(P0.01),秩和检验结果显示,置换灌洗组患者临床疗效优于对照组患者(P0.01);置换灌洗组患者不良反应发生率显著低于对照组患者(P0.05)。结论 CT引导下无水乙醇置换灌洗配合高渗葡萄糖硬化治疗单纯性肾囊肿可避免外科手术治疗复杂、效果欠佳、并发症多、费用高等缺点,目前是较安全可靠的治疗手段,值得临床推广应用。     

经皮胆囊穿刺引流加化学灭活治疗老年急性胆囊炎的临床疗效分析

目的：探讨经皮胆囊穿刺引流加化学灭活治疗老年急性胆囊炎的疗效。方法回顾分析37例施行经皮胆囊穿刺引流加胆囊化学灭活治疗的老年急性胆囊炎患者的临床资料。结果37例患者均成功施行经皮胆囊穿刺置管引流术,获得有效的胆囊引流,术后6周经引流管注入95％无水酒精进行胆囊化学灭活,未发生胆瘘、出血等并发症,均痊愈出院。随访1～3年无一例再出现“胆囊炎”症状。结论经皮胆囊穿刺引流加化学灭活治疗老年急性胆囊炎,创伤小,简单易行,安全有效。     

B超引导下经皮经肝胆囊穿刺引流治疗高海拔地区高龄高危急性胆囊炎的应用

目的 总结B超引导下经皮经肝胆囊穿刺引流(PTCD)在高海拔地区高龄高危急性胆囊炎患者的治疗经验.方法 分析接受经皮经肝胆囊穿刺引流治疗的50例高龄高危急性胆囊炎患者的临床资料.结果 50例均穿刺置管成功.45例(90%)均获得有效胆囊减压引流.42例(84%)治愈.3例发生胆囊出血,1例发生胆汁腹腔漏,1例发生穿刺窦道及腹腔感染.全组无一例因急性胆囊炎及相关的治疗死亡.结论 经皮经肝胆囊穿刺引流是治疗高海拔地区高龄高危急性胆囊炎患者的一项安全、简便、有效的方法.     

穿刺置管、多次注射无水酒精治疗肝囊肿37例分析

目的评价B超引导下经皮穿刺抽吸注射无水乙醇治疗肝囊肿的临床疗效。方法收集解放军302医院普外科肝囊肿患者的相关临床资料,排除乙醇过敏、有严重出血倾向及患有呼吸系统疾病不能配合屏气者,对符合条件的37例患者行穿刺置管、多次注射无水乙醇硬化治疗。结果放置导管引流囊液数天后,影像学结果显示囊腔明显缩小,拔出导管1个月后,影像学结果显示囊腔消失,治愈23例,有效12例,有效率94.7%。治疗过程中无严重并发症发生。37例患者中,5例在注射过程中出现不同程度面色潮红、头晕、心率加快等醉酒样表现,2例出现肝区疼痛,但均可耐受,随访1年,无1例复发。结论与常规穿刺抽液比较,留置导管、反复注射的方法既可以最大程度地减少囊液残留,提高囊壁坏死程度,又可以避免反复穿刺给患者带来的损伤。     

超声引导下经皮穿刺置管序贯治疗胰腺假性囊肿远期疗效观察

目的:探讨并总结超声引导下经皮穿刺置管序贯治疗胰腺假性囊肿的远期疗效。方法:回顾性分析经保守治疗无效的266例胰腺假性囊肿患者的临床病历资料,其中234例患者行超声引导下经皮穿刺置管序贯治疗,32例患者转外科手术治疗;分析其远期疗效及影响因素。结果:266例患者共有298个胰腺假性囊肿,234例经皮穿刺置管序贯治疗的患者均成功完成超声引导下的置管引流,且未出现胰漏、感染扩散等并发症。225例患者治疗有效,囊腔闭合,囊肿消失,有效率96.2%。其中5例复发,复发率为2.3%。32例外科手术治疗患者,有效率96.7%。1例患者复发,复发率为3.1%。所有患者随访超过12个月。结论:超声引导下经皮穿刺置管序贯治疗胰腺假性囊肿安全有效,具有微创、住院时间短及并发症少等优点。     

Treatment of chronic pancreatitic pleural effusion by percutaneous catheter drainage of abdominal pseudocyst

A 53-year-old man entered the hospital with a large, right chronic pancreatitic pleural effusion. Computed tomographic examination of the abdomen and chest demonstrated a pancreatic pseudocyst that had extended into the mediastinum. After conventional closed-chest tube thoracotomy drainage failed to empty the pleural space, percutaneous abdominal pseudocyst drainage was instituted using computed tomographic guidance. The pleural effusion cleared promptly, and the pancreatic pseudocyst resolved gradually over seven weeks. Following termination of pseudocyst drainage, the patient has remained well for over two years with no recurrence of pancreatitis, pseudocyst, or pleural effusion. In contrast, three earlier patients with a chronic pancreatitic effusion managed conventionally had a complicated hospital course and required surgical intervention; two had recurrent pancreatitis following hospital discharge. Percutaneous catheter placement was unsuccessful in one of these three and, in retrospect, was infeasible in the other two. It is recommended that thoracoabdominal computed tomography be performed in all patients with a chronic pancreatitic pleural effusion, and that percutaneous abdominal catheter drainage be attempted in all patients with an accessible pancreatic or mediastinal pseudocyst. Such treatment may relieve respiratory insufficiency, minimize the risk of empyema or fibrothorax, and may promote pseudocyst closure without the need for surgery.     

Treatment of pancreatic pseudocysts in line with D＇Egidio＇s classification

AIM: To explore the implications of underlying diseases in treatment of pancreatic pseudocysts (PPC). METHODS: Clinical data of 73 cases of pancreatic pseudocyst treated in a 12-year period were reviewed comprehensively. Pancreatic pseudocysts were classified according to the etiological criteria proposed by D'Egidio. The correlation between the etiological classification, measure of treatment and clinical outcome of the patients was analyzed. RESULTS: According to the etiological criteria proposed by D'Egidio, 73 patients were divided into three groups. Group I was comprised of 37 patients with type I pseudocyst, percutaneous drainage was successful in the majority (9/11, 82%) while external or internal drainage was not satisfactory with a low success rate (8/16, 50%). Group II was comprised of 24 patients with type II pseudocyst, and internal drainage was curative for most of the cases (11/12, 92%), but the success rate of percutaneous or external drainage was unacceptably low (4/9, 44%). Group III consisted of 12 patients with type III pseudocyst. Internal drainage or pancreatic resection performed in 10 of these patients produced a curative rate of 80% (8/10) with the correction of the ductal pathology as a prerequisite. CONCLUSION: The classification of pancreatic pseudocyst based on its underlying diseases is meaningful for its management. Awareness of the underlying diseases of pancreatic pseudocyst and detection of the ductal pathology in type II and III pancreatic pseudocysts with endoscopic retrograde cholangiopancreatography may help make better decisions of treatment to reduce the rate of complications and recurrence.     

胰腺假性囊肿治疗方式的临床分析

摘要 目的：分析和探讨各种治疗方法对胰腺假性囊肿（PPC）临床效果。方法：回顾性分析广州市第一人民医院2011年6月-2019年3月收治的45例PPC患者的治疗方式、效果、并发症等临床资料。分为保守治疗组25例和干预治疗组20例。保守治疗组行药物保守治疗;干预治疗组采用内引流、外引流、囊肿切除等治疗。结果：3例患者未经治疗囊肿自行消退,22例患者接受内科治疗好转出院。20例因出现腹痛、发热、呕吐等并发症采取了内引流、外引流或囊肿切除方法治疗,其中19例患者经治疗后好转出院,1例患者死亡。保守治疗组中囊肿直径相较于干预组小,住院天数短,囊肿消退时间长（P均<0.05）。对比不同干预治疗方法的术后感染率、复发率及成功率,经皮穿刺置管外引流术后感染率为100%,感染率高（P均<0.05）。内镜下囊肿穿刺内引流相较于其他干预方法术后复发率明显升高、成功率低（P均<0.05）。结论：PPC大部分患者经保守治疗可自行吸收,当出现较大或复杂性PPC时需干预处理,方法首选内镜支架引流或外科手术治疗。外引流术后感染率高,通常只用于不能耐受手术或手术风险极高的患者。内镜穿刺引液术后复发率高、成功率低。     

Pancreatic pseudocyst located in the liver.

Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Extrapancreatic locations of pancreatic pseudocyst in the liver, pleura, mediastinum, or pelvis have been described. However, a pancreatic pseudocyst located in the liver is an infrequent condition. We present the case of a 46-year-old man with pancreatic pseudocyst located in the liver secondary to chronic alcoholic pancreatitis. During admission, the patient underwent an abdominal CT scan that showed a mass located in the head and body of the pancreas, as well as a thrombosis of the splenic vein. A percutaneous needle aspiration biopsy of the pancreas was obtained under CT guidance, which showed no tumoral involvement. Fourty-eight hours after the procedure the patient developed abdominal pain and elevated serum amylase levels. A pancreatic MRI exam showed two pancreatic pseudocysts, one of them located in the left hepatic lobe, the other in the pancreatic tail. Chronic pancreatitis signs also were found. Enteral nutrition via a nasojejunal tube was administered for two weeks. The disappearance of the pancreatic pseudocyst located in the pancreatic tail, and a subtotal resolution of the pancreatic pseudocyst located in the liver were observed. To date twenty-seven cases of pancreatic pseudocyst located in the liver have been published, most of them managed with percutaneous or surgical drainage.     

Minimally invasive treatment of pancreatic pseudocysts

A pancreatic pseudocyst(PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall.Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage(PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity.Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.     

The role of surgery in pancreatic pseudocyst

BACKGROUND/AIMS: Surgery has been the only option available for many years for treating pseudocyst of the pancreas. Recently, new methods, such as percutaneous drainage, endoscopic transenteric drainage and transpapillary drainage, began to be used for treatment of the pseudocyst. But we have to agree that no single technique offers the desired combination of 100% success and no complications. We'd like to present our surgical experience in the past 14 years. METHODOLOGY: A total of 22 patients were treated for pancreatic pseudocyst (PP) in our departments in Dalin and Hualien Tzu-Chi General Hospital within the last 14 years. They were retrospectively reviewed and followed up until recently. RESULTS: There were 14 (63.6%) males and 8 (36.4%) females aged between 15 and 79 years old (mean age 38.2 years). Dominating symptoms in most patients were epigastric pain, palpable mass, nausea, vomiting, fever and leukocytosis, and persistent elevation of serum amylase. Imaging studies, such as ultrasound, computed tomography (CT) scan, and endoscopic retrograde cholangiopancreatography (ERCP), were helpful in establishing diagnosis. In addition to symptomatic persistent large (>6cm) pseudocyst, various types of complication including infection, gastrointestinal (GI) obstruction, rupture into GI tract, peritonitis, GI bleeding, internal bleeding, and pancreatic ascites were indications for surgery in our cases. Operative procedures composed of external drainage (ED, 9 cases), internal drainage using cystojejunostomy (CJ, 4 cases) and cystogastrostomy (CG, 8 cases), and distal pancreatectomy (1 case). Ten complications (45.5%) included recurrence of cyst (1 in-ED and 1 in CJ), recurrence with pancreaticopleural fistula (1 in ED), colon perforation (1 in ED), delayed massive bleeding (1 in CG), pancreatic fistula (3 in ED), pancreatic abscess (1 in CJ) and persistent pain (1 in CG). Reoperation was needed to check bleeding (1 in CG) and proximal colostomy for colon injury (1 in ED). A case received CJ for recurrence of pseudocyst 9 years later (1 in CJ). Percutaneous drainage with wide bore tube was effective for pancreatic abscess (1 in CJ) and transpapillary drainage with stent was used to relieve pleural effusion with respiratory failure (1 in ED). No mortality occurred in this series. CONCLUSIONS: We believe that surgery, though without flaws, still plays an important role in the management of selected cases of pseudocyst of the pancreas. Surgical intervention, endoscopic drainage, and percutaneous drainage were complementary rather than conflicting alternatives both for the simple and complicated pseudocysts.     

Sandostatin for control of catheter drainage of pancreatic pseudocyst

Primary treatment for pancreatic pseudocyst is evolving from surgical intervention to needle aspiration with catheter drainage. The latter treatment results in a similar rate of resolution but has less patient morbidity. This study evaluated the adjuvant role of Sandostatin, which inhibits basal and stimulated pancreatic secretion, in the management of three patients with pancreatic pseudocysts who had prolonged catheter drainage subsequent to percutaneous drainage. Inhibition of secretion occurred in all three patients, as evidenced by decrease in catheter output, which allowed the catheter to be removed. All three patients have remained asymptomatic for 9, 10, and 15 months, respectively. In summary, Sandostatin decreased persistent catheter drainage from chronic pancreatic pseudocysts.     

A case of splenic pseudocyst complicated by acute pancreatitis

Splenic pseudocyst is a rare disease associated with chronic and acute pancreatitis splenic pseudocyst is treated by distal pancreatectomy and splenectomy. A 47-year old woman with a 10-year history of alcohol abuse presented with epigastric and left upper quadrant pain of 3 days duration. Abdominal CT showed a 4.0×4.5 cm sized cystic lesion in the tail of the pancreas. Analgesics was administrated for the relief of abdominal pain. On the 4th hospital day, the patient complained more of left upper quadrant pain, so we took follow up CT scans. On follow up CT, one large splenic pseudocyst with size of 9.5×4.5×10.0 cm was noted. The patient was treated conservatively by percutaneous catheter drainage and discharged on the 13th hospital day. This case is the first case report of splenic pseudocyst treated conservatively, not by surgery in Korea.     

Therapeutic strategies for pancreatic pseudocysts: experience in Taiwan

BACKGROUND/AIMS: A retrospective study of Chinese patients with pancreatic pseudocysts to compare the results between non-conservative and conservative treatments, and the use of serial serum amylase and imaging in monitoring treatment success. METHODOLOGY: One hundred and sixty-two pseudocyst patients, treated between 1974 and 2003, were divided into two groups, conservative treatment and interventions (percutaneous needle drainage, internal drainage, or resection), and treatment results for these groups compared. RESULTS: Ninety-one cases (56%) showed spontaneous pseudocyst resolution (mean duration to resolution, 33.4 days). Pseudocyst size was less than 5cm in 86 of these cases (94.5%). Excellent symptomatic responses after aggressive treatment were noted in 68 of 71 patients (93.1%) with pseudocysts larger than 5 cm. All percutaneous tube drainage patients had pseudocyst resolution when the pseudocyst size was less than 5 cm. Hyperamylasemia was noted in 114 cases (70.4%) at diagnosis and returned to normal range in those patients whose cysts underwent spontaneous resolution or who had successful operations. CONCLUSIONS: Pancreatic pseudocysts smaller than 5 cm should have conservative treatment or percutaneous needle drainage. Larger pseudocysts should be treated aggressively. Serum amylase and ultrasound examinations are important to evaluate the occurrence of spontaneous resolution or the need for surgical intervention.