Kotelnikova L P, Plaksin S A, Farshatova L I
Vagner Perm State Medical University, Perm, Russia.
Khirurgiia (Mosk). 2019(7):80-86. doi: 10.17116/hirurgia201907180.
To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC).
There were 5 patients with MPC.
Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide.
MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.
介绍纵隔胰腺源性囊肿（MPC）患者的外科治疗结果。
5例MPC患者。
实验室检查显示，3例患者血淀粉酶水平升高1.5至2倍，2例患者尿淀粉酶升高4至5倍。4例患者诊断为胸腔积液，胸腔积液中淀粉酶浓度为5680至48640单位。3例患者获得胰体尾假性囊肿的CT数据，2例患者获得胰头和胰体的CT数据。这些囊肿通过裂孔延伸至后纵隔约3.5至40厘米。3例患者接受了电视辅助胸腔镜手术（VATS）切除胸膜碎片，1例患者接受了开胸手术、肺剥脱术及通过胸腔进行MPC引流。3例患者接受了胰腺引流手术（囊肿胃吻合术、胰管空肠吻合术及囊肿外引流术）。1例小的假性囊肿通过奥曲肽保守治疗成功治愈。
MPC是胰腺炎的一种罕见并发症，常伴有胸腔积液。CT检查和胸腔积液淀粉酶分析是主要诊断方法。外科治疗包括VATS、胸膜碎片清除及胸腔引流、囊肿胃吻合术、胰管空肠吻合术或胰腺假性囊肿外引流术。
