胰腺假性囊肿的治疗研究

目的评价胰腺假性囊肿不同治疗方式的效果。方法对1990年1月至2003年4月收治的128例胰腺假性囊肿不同处理方式的效果及并发症进行回顾性分析。结果128例患者中30例未行手术治疗,其中3例失访,27例在随访期间囊肿自行吸收。B超引导下经皮置管引流组22例,有效率60%。外科手术治疗76例,死亡率5.3%(4/76),手术方式包括:外引流10例,死亡率20%(2/10);囊肿胃吻合术14例,术后消化道出血的发生率为42.9%(6/14),死亡率7.1%(1/14);囊肿空肠Roux-en-Y吻合术28例,术后消化道出血的发生率10.7%(3/28),死亡率0%;囊肿十二指肠吻合术3例,死亡率33.3%(1/3);假性囊肿切除术21例。结论B超引导下经皮置管引流创伤小,操作相对简单,但尚未能完全取代传统手术。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。对于怀疑为真性囊肿或囊腺癌者,应尽量手术切除。

Clinical management of pancreatic pseudocyst

Objective To evaluate the effect of different procedures in the treatment of pancreatic pseudocyst.Methods We retrospectively analyzed the outcome of 128 patients with pancreatic pseudocysts managed from January 1990 to April 2003.Results Pseudocysts healed spontaneously in 27 out of 30 patients undergoing watchful management.Twenty-two cases underwent B-US guided percutaneous catheter drainage;the effective rate of therapy was 60%.Surgical procedures were performed in 76 cases, the overall mortality was 5.3%(4/76).The procedures included external drainage(10 cases)with 2 deaths,cystogastrostomy(14 cases)with 6 complicating postoperative gastrointestinal bleeding 42.9% and 1 death(7.1%),Roux-en-Y cystojejunostomy(28 cases)with 3 postoperative gastrointestinal bleeding (10.7%),cystoduodenostomy(3 cases)with 1 death(33%)and resection of the pseudocyst in 21 cases. Conclusions B-US guided percutaneous catheter drainage is of minimal invasion and good alternative to traditional open external drainage.Surgical procedures are still indicated for significant number of patients. The incidence of postoperative gastrointestinal bleeding in cystogastrostomy is higher than that in Roux-en-Y cystojejunostomy.In patients with suspected neoplastic cysts,resection is indicated.