计算机断层扫描引导下引流及内镜引流失败对胰腺假性囊肿治疗的影响。

Effect of failed computed tomography-guided and endoscopic drainage on pancreatic pseudocyst management.

作者信息

Rao R, Fedorak I, Prinz R A

机构信息

Department of Surgery, Loyola University Medical Center, Maywood, IL 60153.

出版信息

Surgery. 1993 Oct;114(4):843-7; discussion 847-9.

PMID:8211703

Abstract

BACKGROUND

Computed tomography and endoscopic drainage are used increasingly to treat pancreatic pseudocysts (PP). We reviewed our experience with PP to compare the outcomes of patients operated on initially (group 1) with those whose nonoperative treatment failed (computed tomography-guided or endoscopic drainage) before operation (group 2).

METHODS

The records of 70 consecutive patients operated on for PP were reviewed. The 52 patients (74%) in group 1 and 18 (26%) in group 2 were compared in terms of clinical features, laboratory test results on examination and before operation, operative findings, morbidity, mortality, and recurrence rates.

RESULTS

Before the initial drainage attempt, mean serum amylase level was higher in group 2 (542 +/- 25 vs 163 +/- 17 IU/L; p = 0.01). All other laboratory values were similar. Before operative drainage, group 2 patients had lower hemoglobin (10.7 +/- 0.5 vs 12.2 +/- 0.3 gm/dl; p < 0.05) and serum albumin level (2.7 +/- 0.2 vs 3.5 +/- 0.1 mg/dl; p < 0.01) than group 1. Morbidity was twice as frequent in group 2 (33% vs 14%). The time from initial attempt at drainage to PP resolution was longer in group 2 (104 +/- 36 vs 20 +/- 4 days; p = 0.01). However, the time from operation to resolution was similar in both groups (21 +/- 8 vs 20 +/- 4 days).

CONCLUSIONS

Failed nonoperative drainage is associated with a protracted illness and carries a risk of increased morbidity after operative intervention.

摘要

背景

计算机断层扫描和内镜引流越来越多地用于治疗胰腺假性囊肿（PP）。我们回顾了我们治疗PP的经验，以比较最初接受手术治疗的患者（第1组）与那些非手术治疗失败（计算机断层扫描引导或内镜引流）后再行手术的患者（第2组）的治疗结果。

方法

回顾了70例连续接受PP手术治疗患者的记录。比较了第1组的52例患者（74%）和第2组的18例患者（26%）的临床特征、检查时和手术前的实验室检查结果、手术发现、发病率、死亡率和复发率。

结果

在首次尝试引流前，第2组的平均血清淀粉酶水平较高（542±25 vs 163±17 IU/L；p = 0.01）。所有其他实验室值相似。在手术引流前，第2组患者的血红蛋白（10.7±0.5 vs 12.2±0.3 gm/dl；p < 0.05）和血清白蛋白水平（2.7±0.2 vs 3.5±0.1 mg/dl；p < 0.01）低于第1组。第2组的发病率是第1组的两倍（33% vs 14%）。第2组从首次尝试引流到PP消退的时间较长（104±36 vs 20±4天；p = 0.01）。然而，两组从手术到消退的时间相似（21±8 vs 20±4天）。