Ann Ital Chir. 2020;91:112-115.
Pancreatic pseudocyst is a complication of acute and chronic pancreatitis, which requires treatment in correlation with its size, symptomatology and mass effect on adjacent structures. Currently, pseudocyst drainage can be done within the stomach or small intestine through endoscopic, laparoscopic or open surgery approach.
In this paper we present a hybrid surgical technique applied by our team on 3 consecutive patients with pancreatic pseudocyst.
The pseudocysts were in all cases internally drained by endoscopic assisted laparoscopic approach, this article highlighting the technical aspects of this procedures. The patients were known with repeated episodes of acute pancreatitis. Imaging examinations indicated the presence of large pancreatic pseudocysts in all cases, for which we decided to perform a mechanical pseudo-cysto-gastro-anastomosis done laparoscopically-trans-gastric through a single trocar under endoscopic guidance.
The length of surgery was from 60 to 90 min with no intraoperative blood loss recorded. The laparoscopic ultrasound was used in all cases to facilitate the safe localization of the future anastomotic site. The laparoscopic examination of the pseudocyst cavity was done systematically and in 2 cases revealed necrotic areas requiring debridement. The patients had no postoperative complications and were discharged 4-6 days after surgery.
Internal drainage of pancreatic pseudocyst inside the stomach, by the technique described above, is facile, giving the patient the advantages of endoscopy and minimally invasive surgery. In these circumstances, we consider it superior to endoscopic drainage, by providing a broad communication between the pseudocyst and stomach cavity, reducing the risk of relapse and abscess formation. Moreover, it offers the possibility of exploring the pseudocyst cavity and of removing any necrotic tissues. The endoscopic assistance makes possible the single trans-gastric trocar approach, limiting the injury of the gastric wall.
Endoscopic assisted laparoscopic procedure, Hybrid technique, Pancreatic pseudocyst, Pseudo-cystogastro- anastomosis technique.
胰腺假性囊肿是急性和慢性胰腺炎的并发症，需要根据其大小、症状和对邻近结构的肿块效应进行治疗。目前，假性囊肿可以通过内镜、腹腔镜或开放手术途径在胃或小肠内引流。
本文介绍了我们团队在 3 例连续胰腺假性囊肿患者中应用的一种混合手术技术。
所有病例均通过内镜辅助腹腔镜方法进行假性囊肿内引流，本文重点介绍了该手术的技术要点。这些患者均有反复发作的急性胰腺炎病史。影像学检查均提示所有病例均存在大的胰腺假性囊肿，我们决定经内镜引导下通过单一套管进行腹腔镜经胃机械性假性囊肿胃吻合术。
手术时间为 60-90 分钟，无术中失血记录。所有病例均使用腹腔镜超声辅助以安全定位未来的吻合部位。系统地对假性囊肿腔进行腹腔镜检查，其中 2 例发现需要清创的坏死区域。患者术后无并发症，术后 4-6 天出院。
通过上述技术在胃内对胰腺假性囊肿进行内引流，简便易行，使患者同时受益于内镜和微创手术。在这种情况下，我们认为它优于内镜引流，因为它在假性囊肿和胃腔之间提供了更广泛的沟通，降低了复发和脓肿形成的风险。此外，它还提供了探查假性囊肿腔和清除任何坏死组织的可能性。内镜辅助使得单一经胃套管途径成为可能，减少了胃壁的损伤。
内镜辅助腹腔镜手术、混合技术、胰腺假性囊肿、假性囊肿胃吻合术。
