胰腺巨大假性囊肿27例的外科治疗

目的 探讨巨大胰腺假性囊肿的临床特点,并对各种外科治疗方法进行评价.方法 对1991年2月至2008年2月收治的27例巨大胰腺假性囊肿(长径>10cm)的临床资料进行回顾性分析.结果 27例巨大胰腺假性囊肿约占同期全部胰腺假性囊肿的20.9%;病因分类:急性胰腺炎所致占51.9%,胰腺外伤和手术所致占33.3%,慢性胰腺炎所致占11.1%;病程小于6周者占绝大多数(21/27);30%患者出现上消化道梗阻(8/27);影像学上虽然囊肿巨大,但均为单房囊肿;ERCP检查发现多数囊肿与胰管相通(9/11).手术方式包括囊肿外引流术9例,均失败,改行其他内引流术.囊肿胃吻合术10例,1例失败,改行囊肿空肠引流术,ERCP胰腺导管囊肿内支架引流术2例,1例失败,改行囊肿空肠引流术,囊肿空肠Roux-en-Y吻合术17例(其中11例为采用其他手术方式治疗失败者).所有患者均临床治愈.结论 胰腺巨大假性囊肿多数出现胰管解剖学改变,外科治疗时机和适应证有别于一般性胰腺假性囊肿.

Surgical treatment for huge pancreatic pseudocysts

Objective To explore the clinical characteristics of huge pancreatic pseudocysts and to evaluate the effect of different surgical treatments. Method We retrospectively analyzed the clinical data of 27 patients with huge pancreatic pseudocyst managed from Feb 1991 to Feb 2008. Result Among a total of 129 patients with pancreatic pseudocyst treated during this period of time,27 (20.9% ) patients were diagnosed as with huge pancreatic pseudocyst (diameter > 10cm). As to the etiology, 51.9% of the psudoeyst was caused by acute pancreatitis, 33.3% by pancreatic trauma and previous surgery, 11.1% by chronic pancreatitis. Pseudoeysts in the majority of cases(21/27)had a history less than 6 weeks. Upper GI obstruction complicated 30% cases (8/27). Imaging showed that all huge pancreatic pseudocysts were single. ERCP showed communication with the main pancreatic duct in 9 out of 11 cases. Nine cases underwent catheter drainage, 10 cases underwent cystogastrostomy,2 cases underwent endoscopic drainage of pancreatic pseudocyst via ERCP, 17 cases underwent Roux-en-Y cystojejunostomy including 11 cases in which other previous procedures failed. All 27 cases were finally cured. Conclusions Huge pancreatic pseudocyst might have unique clinical characteristics. Anatomical changes of main pancreatic duct were found in most cases under ERCP. The proper time and indication for surgical intervention might be different from minor pancreatic pseudocyst.