Iso Yukihiro, Kubota Keiichi
Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
Surg Laparosc Endosc Percutan Tech. 2013 Jun;23(3):330-3. doi: 10.1097/SLE.0b013e31828e3675.
Drainage of cystic contents is the standard treatment for case of pancreatic pseudocyst (PP) with symptoms, complications, or enlargement of the cyst itself. Here, we report an intragastric stapled pancreatic pseudocystgastrostomy involving a combination of laparoscopy and transoral endoscopy. The patient was a 56-year-old man with a history of heavy alcohol intake. He complained of abdominal pain and high fever during hospitalization because of pancreatitis. Diagnostic imaging revealed a large pseudocyst expanding from the pancreatic parenchyma to the anterior abdominal wall. Intragastric stapled pancreatic pseudocystgastrostomy under endoscopic guidance was performed for relief of compression and continuous fever. A 12-mm port was inserted into the peritoneal cavity in the subumbilical region to create a pneumoperitoneum. Initially, an endoscope was inserted transorally into the stomach to identify the region of the posterior gastric wall compressed by the cyst. Two 12-mm ports were created in the stomach using a Funada-style percutaneous endoscopic gastrostomy kit. After penetrating the gastric wall and the PP with laparoscopic coagulating shears, 950 mL of cyst fluid was aspirated. A cystgastrostomy was then accomplished using an Endo-GIA linear stapler. A 5-mm port was added, and reinforcement of the connection between the posterior gastric wall and the PP was performed by hand sewing. There were no intraoperative complications, and all wounds were closed from the outside. Oral intake was started on postoperative day 3, and the postoperative course was uneventful. There was no recurrence during a follow-up period of 36 months. As intragastric stapled pancreatic pseudocystgastrostomy under endoscopic guidance is safe and effective, it can be considered a useful alternative procedure for treatment of symptomatic PP.
对于有症状、并发症或囊肿本身增大的胰腺假性囊肿（PP）病例，引流囊肿内容物是标准治疗方法。在此，我们报告一例腹腔镜与经口内镜联合的胃内吻合胰腺假性囊肿胃造口术。患者为一名56岁男性，有大量饮酒史。他因胰腺炎住院期间出现腹痛和高热。诊断性影像学检查显示一个大的假性囊肿从胰腺实质延伸至前腹壁。在内镜引导下进行胃内吻合胰腺假性囊肿胃造口术以缓解压迫和持续发热。在脐下区域将一个12毫米的端口插入腹腔以建立气腹。最初，经口将内镜插入胃内以确定被囊肿压迫的胃后壁区域。使用舟田式经皮内镜胃造口术套件在胃上创建两个12毫米的端口。用腹腔镜凝固剪穿透胃壁和胰腺假性囊肿后，抽出950毫升囊肿液。然后使用Endo - GIA线性缝合器完成囊肿胃造口术。增加一个5毫米的端口，通过手工缝合加强胃后壁与胰腺假性囊肿之间的连接。术中无并发症，所有伤口均从外部缝合。术后第3天开始经口进食，术后过程顺利。在36个月的随访期内无复发。由于内镜引导下胃内吻合胰腺假性囊肿胃造口术安全有效，它可被视为治疗有症状胰腺假性囊肿的一种有用的替代手术。
