93例胰腺假性囊肿的诊断及治疗

目的 胰腺假性囊肿为急、慢性胰腺炎及胰腺损伤的常见并发症之一。本病的诊断及治疗尚待进一步探讨。方法 回顾分析我院1970.1-2001.8收治的胰腺假性囊肿93例。其中男66例，女27例；平均年龄30.2(5-67岁）；病史20天至18个月。平均4.6个月。表现为腹痛（90.3%)、腹部包块（77.42%)、腹胀（61.29%)、恶心呕吐（38.71%)、纳差（26.88%)、体重下降（11.83%)、发热（7.53%)、黄疸（5.38%)、腹泻（5.38%)、呼吸困难（3.23%）、无明显症状者（9.68%)。病因为急性胰腺炎（55.91%)、慢性胰腺炎（7.53%)、外伤（32.26%)、病因不明者（6.93%)、除病史，症状及体征之外，借助于B超，CT、MRI及ERCP等和实验室检查确定诊断，其中多发性囊肿占7.53%。B超引导下经皮穿刺置管引流（6.98%)。结果 经皮穿刺置引流7例中有4例复发或感染而改为手术治疗，囊肿-空肠Roux-en-y式吻合术后因感染或出血而再次手术10.89%，外引流带管3个月以上者3.49%。本组术后总并发症率为13.98%。无死亡病例，远期治愈率为100%。结论 胰腺假性囊肿占胰腺囊性病变的80%以上，可出现多种并发症（感染、出血、胃肠道梗阻、消化道、泌尿道瘘、破裂等）且需与多种囊性病变相鉴别。诊断及治疗尚有一定困难。作者认为囊肿-空肠Roux-en-y吻合术仍不失为一种简单易行而疗效可靠的方法，经皮穿刺及内窥镜治疗虽创伤小，操作简便。但引流欠彻底，囊腔感染或形成胰瘘的机率相对较高，应进一步探讨。

Diagnosis and treatment of 93 patients with pancreatic pseudocyst

Objective To andlyze the diagnosis and treatment methods of pancreatic pseudocyst.Methods Ninety three cases of pancreatic pseudocyst were collected and analyzed,who were operated from January 1970 to August 2001 in First Affiliated Hospital of Lanzhou Medical College.Male was 66 cases and female was 27 cases with average ages of 30 2(5-67),and average medical history of 4 6 month(20 days to 18 months).Clinical manifestations were upper abdominl pain(90 3%),abdominal nass(77 42%),distension(61 29%),nausea and vomiting(38 71%),weight loss(11 83%),jaundice(5 38%),fever(7 53%),diarrhea(5 38%),dyspnoea(3 23%).And absent symptom was 9 68%.The causes of disease were acute pancreatits(55 91%),chronic pancreatitis(7 53%),injury(32 26%)and the others(4 30%).The diagnosis was made according to history,symptoms,signs,B ultrasound,CT,MRI and ERCP.Multiple and solitary cysts were 7 53% and 92 47% respectively.The treatment consisted of percutaneous puncture catheter drainage 7 cases,cystojejunostomy to Reux en y jejunal limb 91 86%,cystogastomy 1 case,excisional treatment 3 01%,and external drainage 6 98%.Results The results showed that 4 out of 7 patients treated with percutaneous puncture catheter drainage was relapsed or infected and required to be reoperated.10 89% of cystojejunostomy to Reux en y jejunal limb was reoperated due to infection or bleeding.The cxternal drainage with a catheter longer than 3 month was 3 49%.Complication rate after operation was 13 98%.There was no death case.The long term curative rate was 100%.Conclusion Pancreatic pseudocyst is about 80% among pancreatic cystic diseases.Multiple complications may occur such as infection,bleeding,gastrointestinal obstruction,gastrointestinal and urinary tract fistula,and cyst rupture, et al. There are certain difficulties to diagnose and treat pancreatic psudocyst,.and it needs to identify with multiple cystic structures in the surrounding area of the pancreas.The author thinks that cystojejunostomy to Reux en y jejunal limb is a simple,reliable and effective method.Though treatment by percutaneous puncture and endoscope is less trauma and simple performance,their drainage is not complete.The probability of infection in cystic cavity and formation of pancreatic fistula is relatively higher,and it should be probed into further.