Thomasset Sarah C, Berry David P, Garcea Giuseppe, Ong Seok L, Hall Thomas, Rees Yvonne, Sutton Christopher D, Dennison Ashley R
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.
ANZ J Surg. 2010 Sep;80(9):609-14. doi: 10.1111/j.1445-2197.2010.05402.x. Epub 2010 Aug 19.
A number of methods are available for the drainage of pancreatic pseudocysts, including percutaneous, endoscopic and open approaches. In Leicester, we developed a combined radiological and endoscopic technique (predating the use of endoscopic/ultrasound) to allow drainage of pancreatic pseudocysts into the stomach. The aim of the study was to evaluate the long-term results of this approach.
This is a retrospective study of patients undergoing combined endoscopic/ultrasound-guided percutaneous stenting between 1994 and 2007. Data were extracted from case records and our computerised radiology database.
Thirty-seven combined endoscopic/ultrasound-guided procedures were undertaken. Median patient age was 52 years (range 26-84 years). Nineteen pseudocysts were secondary to acute pancreatitis and 18 were in patients with chronic pancreatitis. The diameter of pseudocysts on pre-procedure imaging ranged from 4 to 21 cm (median 11 cm). Median duration of hospital stay was 7 days (range 1-44 days) and 30-day mortality was 0%. Stents were inserted in 70.3% of patients (n= 26). Of those patients stented during the combined procedure, three developed infection of the pseudocyst, necessitating open cystgastrostomy within the first month. During a mean follow-up period of 41 months, two patients developed recurrent pseudocysts which were successfully drained with a further combined procedure (16 and 43 months). Repeat imaging in the remainder of patients failed to show any evidence of a persistent or recurrent pseudocyst beyond 2 months.
Combined radiological and endoscopic drainage is safe, cost-effective and highly efficient in preventing recurrent pseudocyst formation.
有多种方法可用于胰腺假性囊肿的引流，包括经皮、内镜和开放手术。在莱斯特，我们开发了一种联合放射学和内镜技术（早于内镜/超声的使用），以使胰腺假性囊肿引流至胃内。本研究的目的是评估该方法的长期效果。
这是一项对1994年至2007年间接受内镜/超声引导下经皮联合支架置入术患者的回顾性研究。数据从病例记录和我们的计算机放射学数据库中提取。
共进行了37例内镜/超声引导下的联合手术。患者中位年龄为52岁（范围26 - 84岁）。19个假性囊肿继发于急性胰腺炎，18个发生在慢性胰腺炎患者中。术前影像学检查显示假性囊肿直径为4至21厘米（中位值11厘米）。中位住院时间为7天（范围1 - 44天），30天死亡率为0%。70.3%的患者（n = 26）置入了支架。在联合手术期间置入支架的患者中，3例发生假性囊肿感染，需要在第一个月内行开放性囊肿胃造口术。在平均41个月的随访期内，2例患者出现复发性假性囊肿，通过再次联合手术成功引流（分别在16个月和43个月）。其余患者在2个月后的重复影像学检查未显示任何持续性或复发性假性囊肿的证据。
联合放射学和内镜引流在预防复发性假性囊肿形成方面安全、经济有效且高效。
