胰腺假性囊肿治疗方式的临床分析

Clinical analysis on the treatment of pancreatic pseudocyst

目的:分析和探讨各种治疗方法对胰腺假性囊肿(PPC)临床效果。方法:回顾性分析广州市第一人民医院2011年6月-2019年3月收治的45例PPC患者的治疗方式、效果、并发症等临床资料。分为保守治疗组25例和干预治疗组20例。保守治疗组行药物保守治疗;干预治疗组采用内引流、外引流、囊肿切除等治疗。结果:3例患者未经治疗囊肿自行消退,22例患者接受内科治疗好转出院。20例因出现腹痛、发热、呕吐等并发症采取了内引流、外引流或囊肿切除方法治疗,其中19例患者经治疗后好转出院,1例患者死亡。保守治疗组中囊肿直径相较于干预组小,住院天数短,囊肿消退时间长(P均<0.05)。对比不同干预治疗方法的术后感染率、复发率及成功率,经皮穿刺置管外引流术后感染率为100%,感染率高(P均<0.05)。内镜下囊肿穿刺内引流相较于其他干预方法术后复发率明显升高、成功率低(P均<0.05)。结论:PPC大部分患者经保守治疗可自行吸收,当出现较大或复杂性PPC时需干预处理,方法首选内镜支架引流或外科手术治疗。外引流术后感染率高,通常只用于不能耐受手术或手术风险极高的患者。内镜穿刺引液术后复发率高、成功率低。

Objective:To analyze and explore the clinical effects of various treatment methods on pancreatic pseudocyst(PPC).Methods:The therapy methods,effects,complications and other clinical data of 45 cases of PPC from June 2011 to March 2019 in Guangzhou First People's Hospital were retrospectively analysed.There were 25 cases in the conservative treatment group and 20 cases in the intervention treatment group.The conservative treatment group was treated with drugs.The intervention group was treated with internal drainage,external drainage or cyst resection.Results:There were 3 cases of spontaneous regression without treatment,and 22 patients were discharged after receiving active medical treatment.A total of 20 patients with abdominal pain,fever,vomiting and other related complications accepted the treatment of internal drainage,external drainage or cyst resection.Among them,19 patients were discharged after treatment,and 1 patient died of ineffective treatment.The size of cysts in the conservative treatment group was smaller,the length of hospital stay was shorter,and the time needed for cyst regression was longer than in the intervention group(P<0.05).The infection rate after percutaneous catheter placement was 100%(P all<0.05).The recurrence rate of endoscopic aspiration and drainage for PPC increased and the success rate decreased as compared with other intervention methods(P<0.05).Conclusion:PPCs in most patients can be absorbed by themselves after conservative treatment.Intervention is needed when large or complex PPC occurs.Endoscopic stent drainage or surgical treatment is the first choice.The postoperative infection rate of external drainage is high,which is usually only used in patients who can not tolerate the operation or have a high risk of operation.The recurrence rate after endoscopic aspiration was high,and the success rate was low.