Bhattacharya Debashis, Ammori Basil J
Manchester Royal Infirmary, United Kingdom.
Surg Laparosc Endosc Percutan Tech. 2003 Jun;13(3):141-8. doi: 10.1097/00129689-200306000-00001.
Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search words pancreatic and pseudocysts and all relevant articles in English Language or with English abstracts were retrieved. In addition, cross-references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.
虽然三分之一或更多的胰腺假性囊肿可能会自发消退，但大多数仍需要介入治疗。目前有几种微创治疗方法，包括在放射学引导下经皮引流、内镜下经乳头或经壁引流以及腹腔镜内引流。本文综述了这些治疗方法的操作方法、应用、优点、缺点及结果。利用“胰腺”和“假性囊肿”这两个检索词，对MEDLINE、PREMEDLINE和EMBASE数据库进行了计算机检索，检索出所有英文或带有英文摘要的相关文章。此外，还对已识别文章的参考文献进行了查阅。经皮引流最适用于合并继发感染的假性囊肿以及重症患者或不适于手术的患者。然而，放射学引流有引发继发感染和形成胰外瘘的风险，且复发率较高。内镜下经乳头引流对于与胰管相通且可建立依赖引流的假性囊肿有益。内镜下经壁（经胃或经十二指肠）引流在治疗合并慢性胰腺炎的位置合适的假性囊肿时效果良好，但在处理合并急性坏死性胰腺炎的假性囊肿时，引流失败、继发感染和复发的发生率较高。腹腔镜假性囊肿胃造口术或假性囊肿空肠造口术可实现充分的内引流，便于同时清除急性假性囊肿内的坏死组织，且发病率极低，效果良好。需要进行一项随机对照试验，比较慢性胰腺炎胃后假性囊肿的腹腔镜和内镜引流技术。
