胰腺假性囊肿的临床诊断和外科治疗(附88例临床分析)

Clinical Diagnosis and Surgical Treatment of Pancreatic Pseudocyst (With Clinical Analysis of 88 Cases)

目的探讨胰腺假性囊肿的诊断和外科治疗。方法回顾性总结分析2002年1月-2006年4月间我院收治且行外科治疗的胰腺假性囊肿88例。结果B超检查74例,确诊率为98.6%（73/74）;CT检查71例,确诊率为98.6%（70/71）;MRI检查11例,全部确诊。88例采用的手术方式分别是囊肿空肠Roux-en-Y型吻合术39例,囊肿胃吻合术34例,囊肿十二指肠吻合术2例,囊肿外引流术9例,胰体尾切除＋脾切除3例,囊肿胃吻合术＋囊肿空肠Roux-en-Y型吻合术1例。囊空和囊胃吻合组术后并发症发生率均明显低于外引流组（χ2=12.065,P〈00125;χ2=8.246,P〈0.0125）,而囊空和囊胃吻合组术后并发症发生率差异无显著意义（χ2=0.347,P〉0.0125）;囊胃吻合和外引流组术后复发率均高于囊空吻合组（χ2=7.39,P〈0.0125;χ2=9.06,P〈0.0125）,而囊胃吻合组和外引流组术后复发率差异无显著意义（χ2=0.328,P〉0.0125）。结论B超、CT、MRI等影像学检查均能准确诊断胰腺假性囊肿,囊肿的好发部位主要位于体尾部,囊肿外引流术并发症多,复发率高,仅适合于假性囊肿破裂或感染的患者,通常不易采用,囊肿空肠Roux-en-Y型吻合术与囊肿胃吻合术相比,虽然术后并发症无显著差异,但是术后复发率却明显低于囊胃吻合术,故应将囊肿空肠Roux-en-Y型吻合术作为治疗胰腺假性囊肿的首选术式。其他手术方式,可根据病人情况和医院条件灵活开展。

Objective： To evaluate the result of diagnosis and surgical treatment of pancreatic pseudocyst. Methods： The clinical data of 88cases diagnosed as the pancreatic pseudocyst and treated by surgical method from January 2002 to Apirl 2006 were retrospectively analyzed. Results： Seventyfour cases having B- US, there were 73 positive diagnosis （98.6%）; CT performed in 71 cases there were 70 positive diagnosis （98.6%） ; MRI performed in 11 cased the diagnosis were all positive. The operative methods performed in 88 cases included Roux - en - Y cystojejtmostomy （39 cases）, cystogastrestomy （34 cases）, pancreatoduodenectomy （2 cases）, external drainage （9 cases）, excision of body and tail of pancrea ＋ splenectomy （3 cases）, cystogastrostomy ＋ Roux- en- Y cystojejunostomy （1 case）. The postoperative complications of Roux - en - Y eystojejunostomy and cystogastrostomy were lower than external drainage＇s （χ2 = 12.065, P 〈 0.0125; χ2 = 8.246, P 〈 0.0125）, and no sig- nificant difference between Roux - en - Y cystojejunostomy＇ s and cystogastrostomy＇ s （ χ2= 0.347, P 〉 0.0125）. The recurrence rates of cystogastrostomy and external drainage were greater than Roux- en - Y cystojejunostomy＇ s （χ2=7.39, P 〈 0.0125; 9（2 = 9.06, P 〈 0.0125）, and no significant difference between external drainage and cystogastrostomy （χ2 = 0.328, P 〉 0.0125）. Conclusions： Pancreatic pseudocyst is diagnosed correctly by imaging examinations such as B - US, CT, MRI etc. Pseudocyst＇s predilection site was situated mainly in pancreatic body and tail. External drainage was performed exclusively on the patient whose pancreatic pseudocyst was ruptured or infected because of more postoperative coplications and high reccurence rate. Compare Roux- en- Y cystjoejunostomy to cystogastrostomy, the recurrence rate of Roux- en- Y cystojejunostomy was lower than cystogastrostomy＇ s, but no significant difference in the postoperative complications, so Roux- en- Y cystjeejunostomy was the first choice for the treatment of pancreatic pseudocyst. Other operative methods could be developed according to patient and hospital＇s conditions.