CAJ | 학술논문

目的探讨巨大胰腺假性囊肿的临床特点,并对各种外科治疗方法进行评价.方法对1991年2月至2008年2月收治的27例巨大胰腺假性囊肿(长径>10cm)的临床资料进行回顾性分析.结果 27例巨大胰腺假性囊肿约占同期全部胰腺假性囊肿的20.9%;病因分类:急性胰腺炎所致占51.9%,胰腺外伤和手术所致占33.3%,慢性胰腺炎所致占11.1%;病程小于6周者占绝大多数(21/27);30%患者出现上消化道梗阻(8/27);影像学上虽然囊肿巨大,但均为单房囊肿;ERCP检查发现多数囊肿与胰管相通(9/11).手术方式包括囊肿外引流术9例,均失败,改行其他内引流术.囊肿胃吻合术10例,1例失败,改行囊肿空肠引流术,ERCP胰腺导管囊肿内支架引流术2例,1例失败,改行囊肿空肠引流术,囊肿空肠Roux-en-Y吻合术17例(其中11例为采用其他手术方式治疗失败者).所有患者均临床治愈.结论胰腺巨大假性囊肿多数出现胰管解剖学改变,外科治疗时机和适应证有别于一般性胰腺假性囊肿.
목적 탐토거대이선가성낭종적림상특점,병대각충외과치료방법진행평개.방법 대1991년2월지2008년2월수치적27례거대이선가성낭종(장경>10cm)적림상자료진행회고성분석.결과 27례거대이선가성낭종약점동기전부이선가성낭종적20.9%;병인분류:급성이선염소치점51.9%,이선외상화수술소치점33.3%,만성이선염소치점11.1%;병정소우6주자점절대다수(21/27);30%환자출현상소화도경조(8/27);영상학상수연낭종거대,단균위단방낭종;ERCP검사발현다수낭종여이관상통(9/11).수술방식포괄낭종외인류술9례,균실패,개행기타내인류술.낭종위문합술10례,1례실패,개행낭종공장인류술,ERCP이선도관낭종내지가인류술2례,1례실패,개행낭종공장인류술,낭종공장Roux-en-Y문합술17례(기중11례위채용기타수술방식치료실패자).소유환자균림상치유.결론 이선거대가성낭종다수출현이관해부학개변,외과치료시궤화괄응증유별우일반성이선가성낭종.
Objective To explore the clinical characteristics of huge pancreatic pseudocysts and to evaluate the effect of different surgical treatments. Method We retrospectively analyzed the clinical data of 27 patients with huge pancreatic pseudocyst managed from Feb 1991 to Feb 2008. Result Among a total of 129 patients with pancreatic pseudocyst treated during this period of time,27 (20.9% ) patients were diagnosed as with huge pancreatic pseudocyst (diameter > 10cm). As to the etiology, 51.9% of the psudoeyst was caused by acute pancreatitis, 33.3% by pancreatic trauma and previous surgery, 11.1% by chronic pancreatitis. Pseudoeysts in the majority of cases(21/27)had a history less than 6 weeks. Upper GI obstruction complicated 30% cases (8/27). Imaging showed that all huge pancreatic pseudocysts were single. ERCP showed communication with the main pancreatic duct in 9 out of 11 cases. Nine cases underwent catheter drainage, 10 cases underwent cystogastrostomy,2 cases underwent endoscopic drainage of pancreatic pseudocyst via ERCP, 17 cases underwent Roux-en-Y cystojejunostomy including 11 cases in which other previous procedures failed. All 27 cases were finally cured. Conclusions Huge pancreatic pseudocyst might have unique clinical characteristics. Anatomical changes of main pancreatic duct were found in most cases under ERCP. The proper time and indication for surgical intervention might be different from minor pancreatic pseudocyst.