胰腺假性囊肿手术方式应根据囊肿具体位置制定
|
摘要
为筛选胰腺假性囊肿的手术方法,本研究选取胰腺假性囊肿患者73例,观察各患者手术治疗效果。73例患者中,行囊肿十二指肠吻合术者13例(A组),行囊肿胃吻合术者29例(B组),行囊肿空肠吻合术者19例(C组),行胰腺囊肿切除术者12例(D组)。研究发现,各组间术后复发率、吻合口瘘发生率、吻合口出血发生率、住院时间和治疗费用差异不显著(p>0.05);各组术后72 h丙氨酸氨基转移酶(ALT)、天门冬氨酸转氨酶(AST)和尿素氮(BUN)均较术前显著升高(p<0.05);术后72 h,各组间ALT、AST和BUN差异不显著(p>0.05)。研究表明,可根据胰腺假性囊肿具体位置制定合理的手术方案,取得较好的治疗效果,不同手术方式有其适应条件,不应盲目推崇某种手术方式。
To select the surgical method for pancreatic pseudocyst, 73 cases of pancreatic pseudocyst were selected to observe the surgical treatment effect of each patient. Among the 73 patients, 13 cases were treated with cyst-duodenostomy(group A), 29 cases with cyst-stomach anastomosis(group B), 19 cases with cyst-jejunostomy(group C), and 12 cases with pancreatic cystectomy(group D). It was found that there was no significant difference in postoperative recurrence rate, anastomotic fistula incidence rate, anastomotic bleeding incidence rate,hospitalization time and treatment cost among the groups(p>0.05). The alanine aminotransferase(ALT), aspartate aminotransferase(AST) and urea nitrogen(BUN) were significantly increased in each group at 72 h after operation(p<0.05). There was no significant difference in ALT, AST and BUN among the groups at 72 h after operation(p >0.05). These results indicated that a reasonable operation plan should be made according to the specific location of the pancreatic pseudocyst to obtain good therapeutic effects. Different surgical methods should have their adaptation conditions and some surgical methods should not be recommended blindly.
To select the surgical method for pancreatic pseudocyst, 73 cases of pancreatic pseudocyst were selected to observe the surgical treatment effect of each patient. Among the 73 patients, 13 cases were treated with cyst-duodenostomy(group A), 29 cases with cyst-stomach anastomosis(group B), 19 cases with cyst-jejunostomy(group C), and 12 cases with pancreatic cystectomy(group D). It was found that there was no significant difference in postoperative recurrence rate, anastomotic fistula incidence rate, anastomotic bleeding incidence rate,hospitalization time and treatment cost among the groups(p>0.05). The alanine aminotransferase(ALT), aspartate aminotransferase(AST) and urea nitrogen(BUN) were significantly increased in each group at 72 h after operation(p<0.05). There was no significant difference in ALT, AST and BUN among the groups at 72 h after operation(p >0.05). These results indicated that a reasonable operation plan should be made according to the specific location of the pancreatic pseudocyst to obtain good therapeutic effects. Different surgical methods should have their adaptation conditions and some surgical methods should not be recommended blindly.
引文
Aghdassi A.,Mayerle J.,Kraft M.,Sielenkamper A.W.,Heidecke C.D.,and Lerch M.M.,2008,Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis,Pancreas.,36(2):105-112
Aghdassi A.A.,Mayerle J.,Kraft M.,Sielenkamper A.W.,Heidecke C.D.,and Lerch M.M.,2006,Pancreatic pseudocysts-when and how to treat,HPB(Oxford),8(6):432-441
Cheng F.F.,Zhang H.Y.,Cui M.R.,and Wang T.,2015,Nursing of fully covered self-expanding metal stent for endosonograph-guided transgastric pancreatic pseudocyst drainage,Jiefangjun Huli Zazhi(Nursing Journal of Chinese People's Liberation Army),32(23):52-54(程芳芳,张红燕,崔美荣,王婷,2015,超声内镜引导下经胃穿刺胆道覆膜金属支架引流术治疗胰腺假性囊肿患者的护理,解放军护理杂志,32(23):52-54)
Ding J.N.,2014,Clinical study on reduced glutathione combined with somatostatin in the treatment of severe acute pancreatitis,Shiyong Yaowu Yu Linchuang(Practical Pharmacy&Clinical Remedies),17(10):1353-1357(丁金囡,2014,还原型谷胱甘肽联合生长抑素在重症急性胰腺炎治疗中的临床研究,实用药物与临床,17(10):1353-1357)
Habashi S.,and Dragano v P.V.,2009,Pancreatic pseudocyst,World J.Gastroenterol.,15(1):38-47
He Q.,Sheng Q.S.,Lang R.,and Chen D.Z.,2010,Clinical analysis in the treatment of pancreatic pseudocyst,Gandan Waike Zazhi(Journal of Hepatobiliary Surgery),18(1):29-31(贺强,盛勤松,郎韧,陈大志,2010,胰腺假性囊肿治疗方式的临床分析,肝胆外科杂志,18(1):29-31)
Huang S.C.,Huang X.Q.,and Sun W.J.,2017,Diagnosis and treatment of pancreatic pseudocyst:recent progress,Zhongguo Putong Waike Zazhi(Chinese Journal of General Surgery),26(3):367-374(黄斯诚,黄湘秦,孙维佳,2017,胰腺假性囊肿的诊疗进展,中国普通外科杂志,26(3):367-374)
Li C.J.,and Li J.X.,2015,Clinical efficacy of endoscopic plus laparoscopic treatment for severe acute pancreatitis complicated with pancreatic pseudocyst,Zhongguo Putong Waike Zazhi(Chinese Journal of General Surgery),24(3):389-392(李成军,李金骁,2015,内镜联合腹腔镜治疗重症急性胰腺炎并发胰腺假性囊肿的临床疗效观察,中国普通外科杂志,24(3):389-392)
Liao M.Q.,Liu J.X.,and Xia L.,2016,Progress of treatments of severe acute pancreatitis complicated by pancreatic pseudocyst,Zhongguo Yiyao Daobao(China Medical Herald),13(21):66-69(廖敏琪,刘吉祥,夏亮,2016,重症急性胰腺炎合并胰腺假性囊肿治疗的研究进展,中国医药导报,13(21):66-69)
Liao M.Q.,Zhao Y.S.,Liu J.X.,and Xia L.,2016,Meta-analysis of endoscopic minimally invasive versus surgical operation in the treatment of pancreatic pseudocysts,Zhongguo Yiyao Daobao(China Medical Herald),13(22):52-56(廖敏琪,赵云珊,刘吉祥,夏亮,2016,内镜微创对比外科手术治疗胰腺假性囊肿的Meta分析,中国医药导报,13(22):52-56)
Mai T.Q.,He M.,and Li Y.F.,2017,The clinical analysis of endoscopic and laparoscopic on the treatment of pancreatic pseudocyst,Xiandai Yiqi Yu Yiliao(Modern Instruments&Medical Treatment),23(4):41-43(麦天强,何明,李云峰,2017,内镜及腹腔镜治疗胰腺假性囊肿临床分析,现代仪器与医疗,23(4):41-43)
Shang H.T.,Zhang X.B.,Zhang H.T.,Bao J.H.,and Li Z.L.,2016,Treatment for pancreatic pseudocysts,report of 53cases,Zhonghua Putong Waike Zazhi(Chinese Journal of General Surgery),31(10):832-835(尚海涛,张西波,张鸿涛,鲍建亨,李忠廉,2016,53例胰腺假性囊肿治疗分析,中华普通外科杂志,31(10):832-835)
Wan J.L.,Shi Y.P.,Wang B.,Gong Z.W.,Yang H.,and Yang Y.S.,2017,Clinical effect of laparoscopic internal drainage in treatment of pancreatic pseudocyst,Linchuang Gandanbing Zazhi(Journal of Clinical Hepatology),33(9):1762-1765(万经磊,石耀璞,王彬,龚志文,杨杭,杨永生,2017,腹腔镜胰腺假性囊肿内引流术的疗效观察,临床肝胆病杂志,33(9):1762-1765)
Wang D.R.,Lv L.,Gao S.,and Zhang W.G.,2016,Evaluation of endoscop ic ultrasound-guided transgastric or transpapillary drainage in treatment of pancreatic pseudocyst,Zhongguo Neijing Zazhi(China Journal of Endoscopy),22(8):83-86(王道蓉,吕龙,高山,张卫国,2016,超声内镜下经胃、十二指肠乳头引流治疗胰腺假性囊肿的效果评价,中国内镜杂志,22(8):83-86)
Yu Q.,Yang L.H.,Jia J.F.,and Wang C.F.,2016,The imaging diagnosis and surgical treatment choice of pancreatic cysts,Zhongguo Yikan(Chinese Journal of Medicine),51(7):42-45(于琦,杨龙海,贾军峰,王成锋,2016,胰腺囊肿的影像学诊断和治疗方式选择,中国医刊,51(7):42-45)
Yu Z.Y.,Wu Z.K.,Han J.X.,Zhou H.N.,and Jiao Z.Y.,2014,Laparoscopic cystogastrostomy with posterior approach for pancreatic pseudocyst drainage,Zhongnan Duxue Xuebao(Journal of Central South University(Medical Science)),39(10):1035-1038(俞泽元,武赞凯,韩继祥,周辉年,焦作义,2014,后入路腹腔镜胰腺假性囊肿胃吻合术,中南大学学报(医学版),39(10):1035-1038)
Zhang Q.W.,2016,Study on the efficacy of percutaneous puncture and drainage under ultrasound guidance in the treatment of pancreatic pseudo cyst,Yixue Zongshu(Medical Recapitulate),22(20):4149-4151(张庆玮,2016,超声引导下经皮穿刺引流术治疗胰腺假性囊肿的疗效观察,医学综述,22(20):4149-4151)
Aghdassi A.A.,Mayerle J.,Kraft M.,Sielenkamper A.W.,Heidecke C.D.,and Lerch M.M.,2006,Pancreatic pseudocysts-when and how to treat,HPB(Oxford),8(6):432-441
Cheng F.F.,Zhang H.Y.,Cui M.R.,and Wang T.,2015,Nursing of fully covered self-expanding metal stent for endosonograph-guided transgastric pancreatic pseudocyst drainage,Jiefangjun Huli Zazhi(Nursing Journal of Chinese People's Liberation Army),32(23):52-54(程芳芳,张红燕,崔美荣,王婷,2015,超声内镜引导下经胃穿刺胆道覆膜金属支架引流术治疗胰腺假性囊肿患者的护理,解放军护理杂志,32(23):52-54)
Ding J.N.,2014,Clinical study on reduced glutathione combined with somatostatin in the treatment of severe acute pancreatitis,Shiyong Yaowu Yu Linchuang(Practical Pharmacy&Clinical Remedies),17(10):1353-1357(丁金囡,2014,还原型谷胱甘肽联合生长抑素在重症急性胰腺炎治疗中的临床研究,实用药物与临床,17(10):1353-1357)
Habashi S.,and Dragano v P.V.,2009,Pancreatic pseudocyst,World J.Gastroenterol.,15(1):38-47
He Q.,Sheng Q.S.,Lang R.,and Chen D.Z.,2010,Clinical analysis in the treatment of pancreatic pseudocyst,Gandan Waike Zazhi(Journal of Hepatobiliary Surgery),18(1):29-31(贺强,盛勤松,郎韧,陈大志,2010,胰腺假性囊肿治疗方式的临床分析,肝胆外科杂志,18(1):29-31)
Huang S.C.,Huang X.Q.,and Sun W.J.,2017,Diagnosis and treatment of pancreatic pseudocyst:recent progress,Zhongguo Putong Waike Zazhi(Chinese Journal of General Surgery),26(3):367-374(黄斯诚,黄湘秦,孙维佳,2017,胰腺假性囊肿的诊疗进展,中国普通外科杂志,26(3):367-374)
Li C.J.,and Li J.X.,2015,Clinical efficacy of endoscopic plus laparoscopic treatment for severe acute pancreatitis complicated with pancreatic pseudocyst,Zhongguo Putong Waike Zazhi(Chinese Journal of General Surgery),24(3):389-392(李成军,李金骁,2015,内镜联合腹腔镜治疗重症急性胰腺炎并发胰腺假性囊肿的临床疗效观察,中国普通外科杂志,24(3):389-392)
Liao M.Q.,Liu J.X.,and Xia L.,2016,Progress of treatments of severe acute pancreatitis complicated by pancreatic pseudocyst,Zhongguo Yiyao Daobao(China Medical Herald),13(21):66-69(廖敏琪,刘吉祥,夏亮,2016,重症急性胰腺炎合并胰腺假性囊肿治疗的研究进展,中国医药导报,13(21):66-69)
Liao M.Q.,Zhao Y.S.,Liu J.X.,and Xia L.,2016,Meta-analysis of endoscopic minimally invasive versus surgical operation in the treatment of pancreatic pseudocysts,Zhongguo Yiyao Daobao(China Medical Herald),13(22):52-56(廖敏琪,赵云珊,刘吉祥,夏亮,2016,内镜微创对比外科手术治疗胰腺假性囊肿的Meta分析,中国医药导报,13(22):52-56)
Mai T.Q.,He M.,and Li Y.F.,2017,The clinical analysis of endoscopic and laparoscopic on the treatment of pancreatic pseudocyst,Xiandai Yiqi Yu Yiliao(Modern Instruments&Medical Treatment),23(4):41-43(麦天强,何明,李云峰,2017,内镜及腹腔镜治疗胰腺假性囊肿临床分析,现代仪器与医疗,23(4):41-43)
Shang H.T.,Zhang X.B.,Zhang H.T.,Bao J.H.,and Li Z.L.,2016,Treatment for pancreatic pseudocysts,report of 53cases,Zhonghua Putong Waike Zazhi(Chinese Journal of General Surgery),31(10):832-835(尚海涛,张西波,张鸿涛,鲍建亨,李忠廉,2016,53例胰腺假性囊肿治疗分析,中华普通外科杂志,31(10):832-835)
Wan J.L.,Shi Y.P.,Wang B.,Gong Z.W.,Yang H.,and Yang Y.S.,2017,Clinical effect of laparoscopic internal drainage in treatment of pancreatic pseudocyst,Linchuang Gandanbing Zazhi(Journal of Clinical Hepatology),33(9):1762-1765(万经磊,石耀璞,王彬,龚志文,杨杭,杨永生,2017,腹腔镜胰腺假性囊肿内引流术的疗效观察,临床肝胆病杂志,33(9):1762-1765)
Wang D.R.,Lv L.,Gao S.,and Zhang W.G.,2016,Evaluation of endoscop ic ultrasound-guided transgastric or transpapillary drainage in treatment of pancreatic pseudocyst,Zhongguo Neijing Zazhi(China Journal of Endoscopy),22(8):83-86(王道蓉,吕龙,高山,张卫国,2016,超声内镜下经胃、十二指肠乳头引流治疗胰腺假性囊肿的效果评价,中国内镜杂志,22(8):83-86)
Yu Q.,Yang L.H.,Jia J.F.,and Wang C.F.,2016,The imaging diagnosis and surgical treatment choice of pancreatic cysts,Zhongguo Yikan(Chinese Journal of Medicine),51(7):42-45(于琦,杨龙海,贾军峰,王成锋,2016,胰腺囊肿的影像学诊断和治疗方式选择,中国医刊,51(7):42-45)
Yu Z.Y.,Wu Z.K.,Han J.X.,Zhou H.N.,and Jiao Z.Y.,2014,Laparoscopic cystogastrostomy with posterior approach for pancreatic pseudocyst drainage,Zhongnan Duxue Xuebao(Journal of Central South University(Medical Science)),39(10):1035-1038(俞泽元,武赞凯,韩继祥,周辉年,焦作义,2014,后入路腹腔镜胰腺假性囊肿胃吻合术,中南大学学报(医学版),39(10):1035-1038)
Zhang Q.W.,2016,Study on the efficacy of percutaneous puncture and drainage under ultrasound guidance in the treatment of pancreatic pseudo cyst,Yixue Zongshu(Medical Recapitulate),22(20):4149-4151(张庆玮,2016,超声引导下经皮穿刺引流术治疗胰腺假性囊肿的疗效观察,医学综述,22(20):4149-4151)