Department of Surgery, Universidade Estácio de Sá, Rio de Janeiro, Brazil.
Pancreas. 2011 Apr;40(3):469-73. doi: 10.1097/MPA.0b013e31820bf898.
Surgery is the treatment of choice for traumatic pseudocyst. Minimally invasive management of these collections has been used. The aim was to analyze the outcome after endoscopic treatment and the integrity of the main pancreatic duct caused by abdominal trauma.
A total of 51 patients with traumatic pseudocyst who underwent endoscopic therapy were studied. All were symptomatic with a persistent collection for more than 6 weeks. Endoscopic retrograde pancreatography allowed characterization according to Takishima classification (1, 2, and 3), in which guided therapy was divided into transpapillary drainage (Takishima 2 and 3 without bulging), transmural (type 1), or combined (type 2 or 3 with bulging).
Endoscopic retrograde pancreatography was obtained in 47 (90%) of 51 patients. Drainage was transmural in 13, combined in 24, and transpapillary in 10. The success and recurrence rates of endoscopic treatment were 94% and 8%, respectively. There were 9 complications but no procedure-related deaths. Patients with penetrating trauma had more recurrences (P = 0.01) and risk for development of infection (P = 0.045) than those with blunt trauma.
Endoscopic treatment of traumatic pancreatic collection is safe and effective and can be considered a first-choice alternative to surgical treatment. Endoscopic retrograde pancreatography and Takishima classification are useful in determining the best endoscopic approach.
手术是创伤性假性囊肿的首选治疗方法。已经使用了微创方法来管理这些集合。目的是分析经内镜治疗后和腹部创伤引起的主胰管完整性的结果。
研究了 51 例接受内镜治疗的创伤性假性囊肿患者。所有患者均有持续超过 6 周的症状性集合。内镜逆行胰胆管造影允许根据 Takishima 分类（1、2 和 3）进行特征描述，其中引导治疗分为经乳头引流（Takishima 2 和 3 无膨出）、经壁（类型 1）或联合（类型 2 或 3 有膨出）。
47（90%）例 51 例患者获得内镜逆行胰胆管造影。经壁引流 13 例，联合引流 24 例，经乳头引流 10 例。内镜治疗的成功率和复发率分别为 94%和 8%。有 9 例并发症，但无与程序相关的死亡。穿透性创伤患者的复发率（P = 0.01）和感染风险（P = 0.045）高于钝性创伤患者。
内镜治疗创伤性胰腺集合是安全有效的，可以考虑作为手术治疗的首选替代方法。内镜逆行胰胆管造影和 Takishima 分类有助于确定最佳的内镜方法。
