各型胰腺假性囊肿的治疗策略及预后判断

Management and prognostic factors of pancreatic pseudocysts

目的 分析各种急性和慢性胰腺假性囊肿（PPs）的特征和预后,探讨侵入性治疗PPs的预测因子.方法 回顾性分析1995年1月至2004年12月日本医科大学诊治的36例PPs患者的临床资料.将患者分成急性胰腺炎并发的PPs自发缓解组（急性缓解组）;急性胰腺炎并发的PPs症状持续或有并发症需要侵入治疗组（急性治疗组）;慢性胰腺炎并发的PPs自发缓解组（慢性缓解组）和慢性胰腺炎并发的PPs症状持续或有并发症需要侵入治疗组（慢性治疗组）,每组9例.结果 36例患者中,女性13例,男性23例.胰腺炎病因：酒精性18例（50.0%）,胆源性8例（22.2%）,其他原因10例（27.8%）.平均随访时间（24.2±18.5）个月.绝大多数囊肿（32/36,88.9%）与主胰管不相交通;各组囊肿数量、部位均无显著差异;慢性缓解组囊肿直径最小,均〈4 cm,显著小于其他3组（P〈0.05）;两缓解组的囊肿多数无增大,而两治疗组的囊肿绝大多数有增大;急性治疗组中4例（44.4%）囊壁增厚（〉2～3cm）,慢性治疗组中1例（11.1%）囊壁增厚,余囊壁正常.急性PPs的病因多为胆源性,多数位于胰尾,而且这些患者的体表指数、囊肿大小、确诊时有PPs相关症状的例数均显著高于慢性PPs.结论 随访期间PPs体积增大强烈提示需要侵入治疗.慢性PPs囊肿直径〈4 cm是预后良好的指标,急性PPs直径〈8 cm是自然消退的指标.

Objective To investigate the characteristics and prognosis of acute and chronic pancreatic pseudocysts and to identify the predictive factors of interventional treatment of pancreatic pseudocysts. Methods From January 1995 to December 2004, 36 patients with pancreatic pseudocysts at Nippon Medical School were studied retrospectively. Group 1 included 9 patients with acute pancreatitis associated pseudocysts which resolved spontaneously. Group 2 included 9 patients with acute pancreatitis associated pseudocysts and symptoms persisted or with complications which requiring interventional treatment. Group 3 included 9 patients with chronic pancreatitis associated pseudocysts which resolved spontaneously. Group 4 included 9 patients with chronic pancreatitis associated pseudocysts with symptoms persisted or with complications which requiring interventional treatment. Results Among the 36 patients, there were 13 women and 23 men. The etiology of pancreatitis due to alcohol was 18（50.0%） cases, biliary tract disease 8（22.2%）cases, others 10（27.8%） cases. The average duration of follow up was （24. 2 ± 18.5） months. The majority of pseudocysts （32/36, 88.9%） were not communicated with the main pancreatic duct;the number and location of the 4 groups of pseudocysts were not significantly different;the biggest diameter of pancreatic pseudocysts in group 3 was the smallest, all below 4 cm, which was significantly less than those in other 3 groups （P 〈 0.05） ;the majority of volume of pancreatic pseudocysts in group 1 and 3 was not increased, while it was increased in group 2 and 4.