胰腺假性囊肿治疗方式的选择与评价

目的 对胰腺假性囊肿的治疗方式和效果进行评价。方法 对1990年1月至2002年3月收治的114例胰腺假性囊肿的处理方式、效果及并发症进行回顾性分析。结果 25例未行手术治疗,其中23例在随访期间囊肿自行吸收。CT引导下经皮置管引流组29例,有效率67．85％。外科手术治疗60例,死亡率5％(3／60),手术方式包括：外引流8例,死亡率12．5％(1／8);假性囊肿切除13例;囊肿十二指肠吻合1例;囊肿胃吻合19例,术后消化道出血的发生率为36．8％(7／19),死亡率5．26％(1／19);囊肿空肠Roux-en-Y吻合19例,术后消化道出血的发生率为15．8％(3／19),死亡率5．26％(1／19)。结论 CT引导下经皮置管引流创伤小,操作相对简单,是传统开腹外引流术的有效替代方式。虽然微创技术使胰腺假性囊肿的治疗方式多样化,但仍有不少患者需要外科手术治疗。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,但多数易于控制,仍然是一种简单合理的内引流术式。对于难以排除恶性的假性囊肿,应尽量手术切除。

Evaluation and selection of different procedures in the treatment of pancreatic pseudocyst

Objective To evaluate the effect of different procedures in the treatment of pancreatic pseudocyst. Method This retrospective review analyzed the outcome of 114 patients with pancreatic pseudocysts managed in PUMC Hospital from January 1990 to March 2002. Result There were 25 patients without intervention, the spontaneous resolution of pseudocysts occurred in 23 of these patients during follow up. Twenty-nine cases underwent CT-guided percutaneous catheter drainage; the effective rate of therapy was 67.85%. Surgical procedures performed in 60 cases and the overall mortality was 5%(3/60). The procedures included external drainage (8 cases) with 1 death (12.5%), excision (13cases), cystduodenostomy (1 cases), cystgastrostomy (19 cases) with 7 postoperative gastrointestinal bleeding (36.8%) and 1 death (5.26%), Roux-en-Y cystjejunostomy (19 cases) with 3 postoperative gastrointestinal bleeding (15.8%) and 1death(5.26%). Conclusions CT-guided percutaneous catheter drainage has the advantage of minimal invasive and simple technique; it can be as an effective substitute method of traditional open external drainage. Although minimally invasive techniques offer a variety of treatment options, surgical procedures are still indicated for significant number of patients. The incidence of postoperative gastrointestinal bleeding in cystgastrostomy was higher than those patients with Roux-en-Y cystjejunostomy, but most of them were not difficult to treatment, so cystgastrostomy is still a simple and reasonable procedure for selected patients. Excision is a correct choice for cases in which pseudocysts cannot be differentiated from neoplastic cysts.