胰腺假性囊肿16例外科治疗体会

Surgical treatment of 16 cases of pancreatic pseudocyst

目的探讨胰腺假性囊肿术前诊断及手术方式选择,总结手术治疗体会。方法回顾性分析16例术前诊断为胰腺假性囊肿的病例,其中6例行经皮置管外引流术,9例行囊肿-空肠、囊肿-胃内引流术,1例行囊肿及部分胰腺切除术。结果 6例经皮置管外引流术患者中2例出现引流管脱出,囊肿复发,最终行内引流术后痊愈。9例内引流患者中2例为囊腺癌,分别于术后第3、4个月临床死亡;1例内引流患者出现胰瘘,经保守治疗后好转;其余6例均好转;1例行囊肿及部分胰腺切除术患者痊愈。结论胰腺假性囊肿治疗方式应个体化,术前与囊性肿瘤鉴别意义重大。术中应进一步探查,当术中探查结果与术前假性囊肿诊断相悖时,应选择外引流术而不选择内引流术。

Objective To analyze the preoperative diagnosis and surgical approach of pancreatic pseudocyst , and sum-marize the experience. Methods 16 cases diagnosed as pancreatic pseudocyst before operation , 6 cases received percuta-neous catheter drainage, 9 cases received cyst-jejunum or cyst-gastric internal drainage, 1 case received cyst and partial pan-createctomy. Results 2 cases of 6 cases received percutaneous catheter drainage appeared drainage tube dislocation ,and pseudocyst recurrence, and recovered through internal drainage at last. 2 cases of 9 cases received internal drainage were diag-nosed as cystadenocarcinoma and died after 3,4 months respectively. 1 case was complicated with pancreatic fistula and recov-ered after conservative treatment, the others recovered well. 1 case received cyst and partial pancreatectomy and recovered. Conclusion The method of the treatment of pancreatic pseudocyst should be individualized , and the diagnosis before opera-tion is important. Exploration should be further during surgery, when there is no clear diagnosis, external drainage should be selected first.