Andrén-Sandberg A, Ansorge C, Eiriksson K, Glomsaker T, Maleckas A
Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
Scand J Surg. 2005;94(2):165-75. doi: 10.1177/145749690509400214.
According to the Atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of acute pancreatitis or pancreatic trauma, whereas a chronic pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of chronic pancreatitis and lack an antecedent episode of acute pancreatitis. It is generally agreed that acute and chronic pseudocysts have a different natural history, though many reports do not differentiate between pseudocysts that complicate acute pancreatitis and those that complicate chronic disease. Observation--"conservative treatment"--of a patient with a pseudocyst is preponderantly based on the knowledge that spontaneous resolution can occur. It must, however, be admitted that there is substantial risk of complications or even death; first of all due to bleeding. There are no randomized studies for the management protocols for pancreatic pseudocysts. Therefore, today we have to rely on best clinical practice, but still certain advice may be given. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic neoplasias. Conservative treatment should always be considered the first option (pseudocysts should not be treated just because they are there). However, if intervention is needed, a procedure that is well known should always be considered first. The results of percutaneous or endoscopic drainage are probably more dependent on the experience of the interventionist than the choice of procedure and if surgery is needed, an intern anastomosis can hold sutures not until several weeks (if possible 6 weeks).
根据亚特兰大分类法，急性假性囊肿是指胰液被纤维组织或肉芽组织壁包裹的积聚物，它由急性胰腺炎或胰腺创伤引起；而慢性假性囊肿是指胰液被纤维组织或肉芽组织壁包裹的积聚物，它由慢性胰腺炎引起，且无前驱急性胰腺炎发作史。人们普遍认为急性和慢性假性囊肿有不同的自然病程，尽管许多报告并未区分并发于急性胰腺炎的假性囊肿和并发于慢性疾病的假性囊肿。对假性囊肿患者进行观察——“保守治疗”——主要基于自发消退可能发生这一认知。然而，必须承认存在并发症甚至死亡的重大风险，首先是出血风险。目前尚无关于胰腺假性囊肿治疗方案的随机研究。因此，如今我们不得不依赖最佳临床实践，但仍可给出某些建议。首先，对于治疗而言，区分急性和慢性假性囊肿很重要，但同时也不能漏诊囊性肿瘤。保守治疗应始终被视为首选方案（假性囊肿不应仅仅因为存在就进行治疗）。然而，如果需要干预，应始终首先考虑一种熟知的方法。经皮或内镜引流的结果可能更多地取决于干预者的经验，而非方法的选择，并且如果需要手术，内吻合术的缝线可能无法维持数周（如果可能，6周）。
