对胰腺炎后胰腺假性囊肿外科处理的重新认识(附25例报告)

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2例继发感染。18例行内引流,包括4例囊液呈脓样者(其中1例细菌培养阳性),均无并发症,随访1～9年无复发。外引流仅3例(12.0％),明显低于国内文献报道的平均值21.7％(P<0.05)。结论:根据囊肿内容物性状来判断是否继发感染并不准确,既使存在感染,在囊壁成熟的前提下应尽量行内引流,术后并无不良后果。而外引流由于其诸多弊端,应慎重选用。

Reappraisal on the Surgical Management of Postpancreatitic Pancreatic Pseudocyst (Report of 25 Cases)

To reappraise the surgical management of postpancreatitic pancreatic pseudocyst and to probe the possibility of treating infected or necrotic pseudocyst with internal drainage. Methods: We ana-lyzed retrospectively the 25 cases of pancreatic pseudocyst due to pancreatitis admitted from 1988 to 1996. Results: Of the 22 operated cases, 6 specimens of cyst liquid suspected of being infected were cultured for bacteria, only 2 cases were proved to be positive. Internal drainage was performed in 18 cases, of which 4 were thought to be infected with 1 positive culture. All of them were exempted from complications after the operation. No recurrence was noted in a 1 to 9 years follow-up. External drainage was performed in 3 cases only(12.0%), significantly less than the average figure(21.7%) reported in the Chinese literature(P< 0.05). Conclusions: It is not reliable to judge whether infection exists by the appearance of the pseudocyst content. Even if infection exists, it is possible to perform internal drainage, in cases with a matured cyst wall. External drainage should be performed only occasionally because of its well-known shortcomings.