胰腺假性囊肿的诊治分析
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摘要
目的 总结38例胰腺假性囊肿的诊治体会。
方法 1993．1～2002．12年10年间我院外科收治的38例胰腺假性囊肿的患者，对其临床资料进行分析。
结果 病因为急性胰腺炎5例(13.1％)，慢性胰腺炎13例(34.2％)，胰腺外伤史9例(23.7％)，胰腺手术史2例(52.6％)，其它不明原因9例(23.6％)。血或囊液淀粉酶升高分别为16／25(64.0％)，4／10(25％)。B超及CT准确率分别为83.3％，88.2％。非手术治疗6例中5例囊肿自行消失，1例死亡。手术治疗32例，外引流术8例，内引流术20例，其他方法4例。外引流术中胰瘘2例，多发性囊肿复发1例，感染死亡1例；内引流术中1例吻合口过小，囊肿再现，经保守治疗囊肿消失，2例多发性囊肿被漏诊，再次手术行内引流而治愈。比较内外引流术两组的住院时间及术后并发症均有显著差异。术后总并发症发生率为12.5％。
结论 B超或CT为诊断PPC最可靠方法；慢性PPC首选内引流术，如囊壁厚度≥1cm可在6周内手术；高度重视多发性假性囊肿的诊断及治疗。
Objective To sum up experiences in diagnosis and treatment for pancreatic pseudocyst(PPC).
Methods Clinical records of 38 patients in our hospital from 1993 to 2002 were retrospectively analysed.
Results The causes of disease were acute pancreatitis 5 cases(13.1%),chronic pancreatitis 13 cases(34.2%),pancreatic injure 9 cases(23.7%),pancreatic ooperation 2 cases(5.26%) and other causes 9 cases(23.6%).Elevation of amylase in serum and cyst-fluid were 16/25(64%) and 8/16(50%).Accurate rate of B-us and CT seperative was 83.3% and 88.2%.Six patients were non-operation,Cyst in 5 patients were disappeared. 32 patients underwent operation,external drainage was performed in 8,internal drainage in 20,others in 4;8 cases by external drainage ,2 cases had pancreatic fistulas, 1 patient died and 1 patient had of recurred cyst.20 cases by internal drainage,1 patient had recurrence of cyst,2 patients had of multiple cysts
were neglected.Quite differenty exists between external drainage and internal
drainage.Total complication rate after operation was 12.5%.
Conlusion Imageing technique (B-us or CT) is the most dependent diagnosis method of PPC.When operation is needed,patients with chronic Ppancreatic pseudocysts should be performed firstly by internal drainage.The diagnosis and treatment of multiple cysts shouled be emphasized.
方法 1993．1～2002．12年10年间我院外科收治的38例胰腺假性囊肿的患者，对其临床资料进行分析。
结果 病因为急性胰腺炎5例(13.1％)，慢性胰腺炎13例(34.2％)，胰腺外伤史9例(23.7％)，胰腺手术史2例(52.6％)，其它不明原因9例(23.6％)。血或囊液淀粉酶升高分别为16／25(64.0％)，4／10(25％)。B超及CT准确率分别为83.3％，88.2％。非手术治疗6例中5例囊肿自行消失，1例死亡。手术治疗32例，外引流术8例，内引流术20例，其他方法4例。外引流术中胰瘘2例，多发性囊肿复发1例，感染死亡1例；内引流术中1例吻合口过小，囊肿再现，经保守治疗囊肿消失，2例多发性囊肿被漏诊，再次手术行内引流而治愈。比较内外引流术两组的住院时间及术后并发症均有显著差异。术后总并发症发生率为12.5％。
结论 B超或CT为诊断PPC最可靠方法；慢性PPC首选内引流术，如囊壁厚度≥1cm可在6周内手术；高度重视多发性假性囊肿的诊断及治疗。
Objective To sum up experiences in diagnosis and treatment for pancreatic pseudocyst(PPC).
Methods Clinical records of 38 patients in our hospital from 1993 to 2002 were retrospectively analysed.
Results The causes of disease were acute pancreatitis 5 cases(13.1%),chronic pancreatitis 13 cases(34.2%),pancreatic injure 9 cases(23.7%),pancreatic ooperation 2 cases(5.26%) and other causes 9 cases(23.6%).Elevation of amylase in serum and cyst-fluid were 16/25(64%) and 8/16(50%).Accurate rate of B-us and CT seperative was 83.3% and 88.2%.Six patients were non-operation,Cyst in 5 patients were disappeared. 32 patients underwent operation,external drainage was performed in 8,internal drainage in 20,others in 4;8 cases by external drainage ,2 cases had pancreatic fistulas, 1 patient died and 1 patient had of recurred cyst.20 cases by internal drainage,1 patient had recurrence of cyst,2 patients had of multiple cysts
were neglected.Quite differenty exists between external drainage and internal
drainage.Total complication rate after operation was 12.5%.
Conlusion Imageing technique (B-us or CT) is the most dependent diagnosis method of PPC.When operation is needed,patients with chronic Ppancreatic pseudocysts should be performed firstly by internal drainage.The diagnosis and treatment of multiple cysts shouled be emphasized.
引文
1 Guice KS, Acute pancreatitis in Greenfild LJ. Surgery, 2nd, ED. Philadelphia:Lippincot-Raven, 1997:87
2 Keith DL,Charles JY. Management of complication of pancreatitis.Current problems in Surgery,1998,35:13-98
3 Jiang yuepin,Chen hanqin.The treatment of cyst anastomosis in multiple cyst.Abdominal Surgery,2000,13(6):358
4 Warshaw AL,Rattner DW. Timing of surgical drainage of pancreatic pseudocysts. Ann Surg,1985,202:720-724
5 Fedorak IJ, Rao RA. The clinical challenge of multiple pancreatic pseudocysts. Am J S ury,1994,168:22
6 Yeo CT, Bastidas J,et al. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Cynecol Obstet,1990,170:411～417
7 Bradley EL, Clements JL..The natural history of pancreatic pseudocysts:a unified concept of management.Am J Surg,1979,137:135
8 Behrman W, Melvin W, Ellisen E.Pancreatic pseudocysts following acute pancreatitis. Am J Surg, 1996,172:228
9 Waren WD, Marsh WH, Muller WH. Experimental prodution of pseudocysts of the pancrease with preliminary observation on internal grainage .Surg Gynecol Obstet, 1975,105:385-387
2 Keith DL,Charles JY. Management of complication of pancreatitis.Current problems in Surgery,1998,35:13-98
3 Jiang yuepin,Chen hanqin.The treatment of cyst anastomosis in multiple cyst.Abdominal Surgery,2000,13(6):358
4 Warshaw AL,Rattner DW. Timing of surgical drainage of pancreatic pseudocysts. Ann Surg,1985,202:720-724
5 Fedorak IJ, Rao RA. The clinical challenge of multiple pancreatic pseudocysts. Am J S ury,1994,168:22
6 Yeo CT, Bastidas J,et al. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Cynecol Obstet,1990,170:411～417
7 Bradley EL, Clements JL..The natural history of pancreatic pseudocysts:a unified concept of management.Am J Surg,1979,137:135
8 Behrman W, Melvin W, Ellisen E.Pancreatic pseudocysts following acute pancreatitis. Am J Surg, 1996,172:228
9 Waren WD, Marsh WH, Muller WH. Experimental prodution of pseudocysts of the pancrease with preliminary observation on internal grainage .Surg Gynecol Obstet, 1975,105:385-387