Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients.
Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients.
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发表时间：
1993
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通讯作者：
M. Barthet;M. Bugallo;Moreira Ls;C. Bastid;B. Sastre;J. Sahel
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作者：
M. Barthet;M. Bugallo;Moreira Ls;C. Bastid;B. Sastre;J. Sahel
1980年至1990年间，对143名患有慢性胰腺炎的170个囊肿和假性囊肿患者进行了随访。其中13名患者接受了保守治疗，其中11名患者的假性囊肿自行消失。囊肿较小（平均28毫米），常与胰管系统相通，主胰管不扩张。 47 例患者进行了经皮穿刺，发病率较低（5%），但复发率较高（57%）。在 39 名接受经皮穿刺作为初始治疗的患者中，有 13 名患者 (33%) 不需要进一步治疗。胰腺囊肿与导管系统的连通与经皮穿刺后效果较差有关。 9 例患者进行了经皮引流，发病率较低（12%）。平均引流持续时间为10.4天。五名患者最终痊愈。对 71 名患者进行了 78 次内镜下膀胱肠造口术。 12 名患者（15.3%）出现并发症，1 名患者死亡（1.3%）。内镜下膀胱肠造口术对 54 名最初接受该技术治疗的患者中的 39 名有效（72.2%）。 63 例患者接受了手术治疗，主要是内引流（83%），发病率为 13.2%，死亡率为 1.3%。接受手术作为初始治疗的 29 名患者中有 21 名 (72%) 不需要进一步治疗。当解剖条件有利时，内镜下膀胱肠造口术是治疗并发 CP 的囊肿和假性囊肿的有效方法。经皮引流似乎也是一种令人满意的治疗方式。如果内窥镜或经皮入路失败或技术上无法实现，则应考虑手术。
One hundred and forty-three patients presenting with 170 cysts and pseudocysts complicating chronic pancreatitis were followed between 1980 and 1990. Thirteen patients were managed conservatively and pseudocysts spontaneously disappeared in 11 patients. Cysts were small (average 28 mm), often communicating with the ductal system without dilatation of the main pancreatic duct. Percutaneous puncture was performed in 47 patients with a low morbidity rate (5%) but a high rate of recurrence (57%). Thirteen of 39 patients (33%) who underwent percutaneous puncture as initial treatment did not require further therapy. Communication of pancreatic cysts with the ductal system was associated with poorer results after percutaneous puncture. Percutaneous drainage was performed in 9 patients with a low morbidity rate (12%). The mean duration of drainage was 10.4 days. Five patients were definitively cured. Seventy-eight endoscopic cystoenterostomies were performed in 71 patients. Complications occurred in 12 patients (15.3%) and one patient died (1.3%). Endoscopic cystoenterostomy was effective in 39 of 54 patients initially treated with this technique (72.2%). Sixty-three patients underwent surgical management, principally internal drainage (83%), with a morbidity rate of 13.2% and a mortality rate of 1.3%. Twenty-one of the 29 patients (72%) who underwent surgery as initial treatment did not require further therapy. Endoscopic cystoenterostomy is an efficient treatment of cysts and pseudocysts complicating CP when anatomical conditions are favorable. Percutaneous drainage also appears to be a satisfactory treatment modality. Surgery should be considered in cases of failure or technical impossibility of endoscopic or percutaneous approaches.