Saluja Sundeep Singh, Srivastava Siddharth, Govind S Hari, Dahale Amol, Sharma Barjesh Chander, Mishra Pramod Kumar
Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India.
Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India.
J Minim Access Surg. 2020 Apr-Jun;16(2):126-131. doi: 10.4103/jmas.JMAS_109_18.
Studies comparing surgical versus endoscopic drainage of pseudocyst customarily include patients with both acute and chronic pseudocysts and the endoscopic modalities used for drainage are protean. We compared the outcomes following endoscopic cystogastrostomy (ECG) and surgical cystogastrostomy (SCG) in patients with acute pseudocyst.
Seventy-three patients with acute pseudocyst requiring drainage from 2011 to 2014 were analysed (18 patients excluded: transpapillary drainage n = 15; cystojejunostomy n = 3). The remaining 55 patients were divided into two groups, ECG n = 35 and SCG n = 20, and their outcomes (technical success, successful drainage, complication rate and hospital stay) were compared.
The technical success (31/35 [89%] vs. 20/20 [100%] P = 0.28), complication rate (10/35 [28.6%] vs. 2/20 [10%]; P = 0.17) and median hospital stay (6.5 days [range 2-12] vs. 5 days [range 3-12]; P = 0.22) were comparable in both the groups, except successful drainage which was higher in surgical group (27/35 [78%] vs. 20/20 [100%] P = 0.04). The conversion rate to surgical procedure was 17%. The location of cyst towards tail of pancreas and presence of necrosis were the main causes of technical failure and failure of successful endoscopic drainage, respectively.
Surgical drainage albeit remains the gold standard for management of pseudocyst drainage; endoscopic drainage should be considered a first-line treatment in patients with acute pseudocyst considering the reasonably good success rate.
比较手术与内镜引流假性囊肿的研究通常纳入急性和慢性假性囊肿患者，且用于引流的内镜方式多种多样。我们比较了急性假性囊肿患者行内镜下囊肿胃造口术（ECG）和手术囊肿胃造口术（SCG）后的结局。
分析了2011年至2014年73例需要引流的急性假性囊肿患者（排除18例：经乳头引流15例；囊肿空肠吻合术3例）。其余55例患者分为两组，ECG组35例，SCG组20例，比较两组的结局（技术成功率、引流成功、并发症发生率和住院时间）。
两组的技术成功率（31/35 [89%] 对20/20 [100%]，P = 0.28）、并发症发生率（10/35 [28.6%] 对2/20 [10%]；P = 0.17）和中位住院时间（6.5天 [范围2 - 12天] 对5天 [范围3 - 12天]；P = 0.22）相当，但手术组的引流成功率更高（27/35 [78%] 对20/20 [100%]，P = 0.04）。手术转换率为17%。囊肿位于胰尾和存在坏死分别是技术失败和内镜引流成功失败的主要原因。
尽管手术引流仍是假性囊肿引流治疗的金标准；但考虑到内镜引流成功率相当不错，对于急性假性囊肿患者应将其视为一线治疗方法。
