Vosoghi Mehrdad, Sial Shahid, Garrett Benedict, Feng Jack, Lee Tonny, Stabile Bruce E, Eysselein Viktor E
Department of Internal Medicine/Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA.
MedGenMed. 2002 Jul 18;4(3):2.
Pancreatic pseudocyst, the most common cystic lesion of the pancreas, is a localized collection of fluid rich in amylase within or adjacent to the pancreas and enclosed by a nonepithelialized wall, occurring as a result of acute or chronic pancreatitis, pancreatic trauma, or pancreatic duct obstruction. Currently, at least 3 major forms of therapy are available: percutaneous drainage, surgical intervention, and endoscopic drainage. Controversy exists concerning which of these techniques should be offered to the patient as initial therapy. Three options exist for the surgical management of pancreatic pseudocysts: excision, external drainage, and internal drainage. Surgery, which traditionally was the major treatment approach for pancreatic pseudocysts, has been challenged by newer endoscopic techniques. Given the low complication and mortality rates and the high success rate of endoscopic drainage when compared with surgery, surgical intervention should be reserved only for certain cases. Addition of endoscopic ultrasonography (EUS) for endoscopic drainage is a new and exciting development and may decrease the risks associated with endoscopic drainage. We report our experience of 14 cases of EUS-guided pancreatic pseudocyst drainage and review the literature for advantages and disadvantages of these pancreatic pseudocyst drainage procedures. Complications, recurrence, success, and mortality rates for each procedure are described. Our approach to pancreatic pseudocyst management is described in the form of an algorithm.
胰腺假性囊肿是胰腺最常见的囊性病变，是胰腺内或胰腺附近富含淀粉酶的局限性液体积聚，被无上皮化的壁包裹，由急性或慢性胰腺炎、胰腺创伤或胰管梗阻引起。目前，至少有3种主要治疗方式：经皮引流、手术干预和内镜引流。对于应将这些技术中的哪一种作为初始治疗提供给患者存在争议。胰腺假性囊肿的手术治疗有3种选择：切除、外引流和内引流。传统上作为胰腺假性囊肿主要治疗方法的手术，受到了更新的内镜技术的挑战。鉴于与手术相比，内镜引流的并发症和死亡率低且成功率高，手术干预应仅保留用于某些病例。在内镜引流中增加内镜超声（EUS）是一项新的、令人兴奋的进展，可能会降低与内镜引流相关的风险。我们报告了14例EUS引导下胰腺假性囊肿引流的经验，并回顾了这些胰腺假性囊肿引流程序的优缺点。描述了每种程序的并发症、复发、成功率和死亡率。我们以算法的形式描述了胰腺假性囊肿的管理方法。
