Objective To summarize some problems about the management of acute pancreatic pseuclocyst (PPC) by CT guided percutaneous drainage (PCD).Methods The recent domestic and foreign literatures were reviewed in order to explore the research advancement, such as indication, applied time, technique skill, complication and curative effect by CT guided PCD. Results This operation could be early performed in patients with acute PPC, preventing and decreasing the incidence of possible complications resulted from the traditional long-term observation and waiting. The technique skill of operation was easy with low incidence of complications and the effect was good. Combined use of somatostatin might shorten the treatment time. Some patients could be postoperatively managed in out-patient, thus the expense could be cut down. Conclusions CT guided PCD is a minimally invasive operation and is easy to perform with high effective rate and low incidence of complications and low cost. Reasonable selection of the indications and improvement of equipments and operation techniques may be helpful to improve the curative effect. The extended application of this operation is advised.
目的:探讨急性胰腺炎(AP)并发胰腺假性囊肿(PPC)的早期诊断、早期治疗方法及疗效观察。方法:急性胰腺炎患者给予常规治疗,每周复查B型超声,必要时复查上腹部CT,一旦检查诊断为胰腺假性囊肿形成,即给予TDP(CQ型特定电磁波治疗器)烤腹部相应囊肿部位皮肤,烤后再以适量黄冰解毒消肿软膏外敷腹部相应囊肿部位皮肤,每周复查B超1次,直致囊肿消失。结果: 63例胰腺假性囊肿56例胰腺假性囊肿经保守治疗后完全消失,有效率8889%(56/63),平均68周时间,最短时间2周,最长时间12周。7例囊肿未消失,其中2例囊肿有缩小,5例无效。结论: 胰腺假性囊肿形成早期诊断,早期联合物理治疗和中药外敷疗效显著,不失为一种安全、有效、经济的治疗方法。
Objective To summarize the treatment of pancreatic pseudo cyst in recent years. Methods Through the retrieval of relevant literatures, the progress in the treatment of pancreatic pseudo cyst in recent years were reviewed. Results Pancreatic pseudo cyst is a common complication of pancreatitis or pancreatic injury. Severe symptoms are often caused by large cysts or complications, and it can cause serious consequences. The main treatment methods are conservative treatment, percutaneous drainage, surgical treatment, endoscopic drainage technology, combined with traditional Chinese and Western medicine treatment, and each method has its own indications and advantages and disadvantages. Conclusion The treatment of pancreatic pseudo cyst is varied, and it should be individualized treatment according to different indications, different patients and the development stage of the disease.
目的 探讨胰腺假性囊肿行内引流治疗的临床效果。方法 对我院2001年1月至2008年12月期间收治的20例胰腺假性囊肿行内引流治疗的临床资料进行回顾性分析。结果 本组20例中行囊肿与胃吻合7例,囊肿与空肠Roux-en-Y吻合13例。14例获得3个月~6年（平均32个月）随访，均获一次性治愈，无近、远期并发症发生。结论 根据囊肿形成的大小和时间选择恰当的内引流治疗方式，能有效治愈胰腺假性囊肿。
Objective To summarize the experience of sequentially minimally invasive treatment for aged and high risk symptomatic pancreatic pseudocyst under ultrasound guided percutaneous catheter drainage combined with endoscopic technique. Methods The clinical data of 30 patients with aged and high risk pancreatic pseudocyst treated from January 2009 to January 2012 in this hospital were analyzed retrospectively. Results Percutaneous tubes were successfully placed in 30 patients， cystic liquid was sufficiently drained， and the compression symptom of cyst was relieved immediately. After stable disease， 12 patients with communicating cysts were diagnosed by using endoscopic retrograde cholangiopancreatography. Pancreatic duct stents were inserted in 12 patients with communicating cysts for 60-90d （with an average 70d） after endoscopic sphincterectomy and endoscopic pancreatic sphincterectomy. Cysts disappeared in the other 18 cases receiving external drainage with external drainage tubes， the drainage time was 15-90 d with an average 30d. Neither recurrence nor complications were found in all the cases during 12-21 months （with an average 18 months） follow-up. Conclusion Interventional ultrasound combined with endoscopic technique sequentially minimally invasive treatment for aged and high risk symptomatic pancreatic pseudocyst has superiorities in little trauma， fewer complications， and exact effect.
Objective To explore treatment strategy of pancreatic pseudocyst induced left-sided portal hypertension (LSPH) complicated with hypersplenism. Methods The clinical data of 49 cases of pancreatic pseudocyst induced LSPH complicated with hypersplenism from January 2010 to June 2015 in this hospital were retrospectively analyzed. Among them, 36 patients who were not complicated with upper gastrointestinal bleeding were designed to splenectomy group and non-splenectomy group based on splenectomy or not. The epidemiological and clinical features, intraoperative and postoperative results of these two groups were compared. Results There were 38 males and 11 females with age ranging from 22 to 67 years old. As for 13 patients suffering LSPH complicated with hypersplenism caused by pancreatic pseudocyst with upper gastrointestinal bleeding, one patient didn’t accept splenectomy, then the upper gastrointestinal bleeding recurred and the hypersplenism was not alleviated after operation; Whereas, the hypersplenisms were relieved in the others patients after operation. In the 36 patients without upper gastrointestinal bleeding who were complicated with hypersplenism, 23 patients were performed splenectomy (splenectomy group) and 13 patients were not (non-splenectomy group). In the splenectomy group, the blood loss, operation time, and intraoperative blood transfusion were significantly more than those of the non-splenectomy group (P<0.05). The hospital stay and the discharged laboratory examinations had no significant differences between the splenectomy group and the non-splenectomy group (P>0.05) except for the platelet count. Furthermore, the incidence of the postoperative upper gastrointestinal bleeding was lower (P<0.05) and the relief rate of hypersplenism was higher (P<0.05) in the splenectomy group as compared with the non-splenectomy group. Conclusions For pancreatic pseudocyst induced LSPH with hypersplenism, we should be vigilant and early intervent. Usually, primary focus can be treated only. However, splenectomy can effectively relieve hypersplenism and prevent recurrent bleeding for patients with upper gastrointestinal bleeding or patients with close adhesion of pancreas tail and spleen inflammatory lesions and constricting splenic hilus.
目的:观察活血化瘀法治疗重症急性胰腺炎并发胰腺假性囊肿的临床效果。方法:对并发假性囊肿的重症急性胰腺炎(severe acute pancreatitis,SAP)患者采用活血化瘀为主,内服中药以桃红四物汤加减,六合丹外敷腹部或胁肋部,丹参注射液静脉滴注。结果:105例并发假性囊肿的SAP患者中14例因感染发生脓肿而手术,12例因假性囊肿压迫胃肠导致不全性肠梗阻而进行择期囊肿内引流术,79例经活血化瘀治疗后好转。结论：大多数SAP并发胰腺假性囊肿可以通过活血化瘀法得到控制,并发感染或者肠梗阻者仍需要积极手术治疗。