重症急性胰腺炎继发假性胰腺囊肿手术时机探讨

目的探讨重症急性胰腺炎后假性胰腺囊肿的手术时机。方法27例胰腺炎后4~8周出现的假性胰腺囊肿,行囊肿内引流术(早期手术组),其中10例采用吻合器行囊肿空肠吻合术。与30例病人囊肿形成后,等待24周再施行手术的(晚期手术组)进行比较。结果两组病例相比,早期手术组的术后吻合口漏发生率、平均住院时间、平均住院费用明显低于晚期手术组,差异有显著性意义(P<0.05),但囊肿逆行感染发生率两组相比差异无显著性意义(P>0.05),晚期手术组有5例在等待手术的过程中出现并发症而急诊手术(1例囊肿内出血,2例囊肿内感染,2例囊肿破裂)。结论术前明确诊断,严格掌握手术指征,早期行假性胰腺囊肿内引流术是安全可行的,且避免了等待过程中囊肿内感染、出血和破裂的发生。

Timing of surgical treatment for pancreatic pseudocyst secondary to severe acute pancreatitis

Objective To determine the timing of surgical treatment for pancreatic pseudocyst(PPC) secondary to severe acute pancreatitis(SAP). Methods Twenty-seven cases of PPC appearing 4-8 weeks after SAP were treated with internal drainage were included in group A.Of the 27 cases,10 received cystojejunostomy by stapler.In other 30 cases in group B,surgical procedures were performed 24 weeks after the formation of the cyst.Several parameters were compared between the 2 groups.Results The incidence of anastomotic leakage,average duration of hospitalization and mean fee for hospitalization were significantly lower in group A than in group B(P<0.05).There was no marked difference in incidence of retrograde cystic infection between the 2 groups(P>0.05).Emergency surgical treatments were performed in 5 patients in group B due to complications of introcystic hemorrhage(1 patients),introcystic infection(2 patients) and cystic rupture(2 patients).Conclusions Accurate diagnosis and early surgical treatments are effective and safe for treatment of PPC secondary to SAP.Meanwhile,they might be helpful for avoiding complications of introcystic infection,introcystic hemorrhage and cystic rupture.