Johnson Michael D, Walsh R Matthew, Henderson J Michael, Brown Nancy, Ponsky Jeffrey, Dumot John, Zuccaro Gregory, Vargo John
Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
J Clin Gastroenterol. 2009 Jul;43(6):586-90. doi: 10.1097/MCG.0b013e31817440be.
Compare patient characteristics and outcome and also physician referral patterns between surgically and nonsurgically managed patients with pancreatic pseudocysts.
Treatment of pancreatic pseudocysts can be accomplished by surgical, endoscopic, or percutaneous procedures. The ideal treatment method has not yet been defined.
All patients treated for pancreatic pseudocyst between 1999 and 2005 were identified in our health services database. Patients were treated with surgical, endoscopic, and percutaneous drainage procedures at the discretion of the treating physician. Main outcome measures included complications, pseudocyst resolution, and treatment modality as a function of the treating physician's specialty.
Thirty patients (49%) were treated surgically, 24 endoscopically (39%), and 7 (11%) with percutaneous drainage. The most common indications for treatment were symptoms of pain, and biliary or gastric outlet obstruction (81%). Patients treated surgically and endoscopically were similar in terms of age (49 vs. 52 y), mean cyst diameter (9.1 vs. 9.5 cm, P=0.74), incidence of chronic pancreatitis (50% vs. 32%, P=0.26) and complicated pancreaticobiliary disease (69% vs. 60%). There were no differences in complications (20% vs. 21%) or pseudocyst resolution (93.3% vs. 87.5%, P=0.39) between the surgical and endoscopic groups. There was no significant difference in the rate of surgical versus nonsurgical treatment in patients initially evaluated by surgeons versus nonsurgeons.
Surgical and endoscopic interventions for pancreatic pseudocysts are equally safe and effective with percutaneous drainage playing a less important role. Endoscopic drainage should be considered for initial therapy in appropriate patients.
比较手术治疗和非手术治疗的胰腺假性囊肿患者的特征、结局以及医生的转诊模式。
胰腺假性囊肿的治疗可通过手术、内镜或经皮穿刺等方法完成。理想的治疗方法尚未明确。
在我们的医疗服务数据库中识别出1999年至2005年间接受胰腺假性囊肿治疗的所有患者。治疗医生可自行决定采用手术、内镜和经皮穿刺引流术对患者进行治疗。主要结局指标包括并发症、假性囊肿消退情况以及治疗方式与治疗医生专业的关系。
30例患者（49%）接受了手术治疗，24例（39%）接受了内镜治疗，7例（11%）接受了经皮穿刺引流治疗。最常见的治疗指征是疼痛症状以及胆管或胃出口梗阻（81%）。接受手术治疗和内镜治疗的患者在年龄（49岁对52岁）、平均囊肿直径（9.1 cm对9.5 cm，P = 0.74）、慢性胰腺炎发病率（50%对32%，P = 0.26）以及复杂胰胆疾病发病率（69%对60%）方面相似。手术组和内镜组在并发症（20%对21%）或假性囊肿消退情况（93.3%对87.5%，P = 0.39）方面无差异。最初由外科医生与非外科医生评估的患者，其手术治疗与非手术治疗的比例无显著差异。
胰腺假性囊肿的手术和内镜干预同样安全有效，经皮穿刺引流的作用较小。对于合适的患者，应考虑将内镜引流作为初始治疗方法。
