杨秀峰++白化天++吕瑞光++张业伟++陈浩伟++折占飞++杨哲

[摘要] 目的 探討急性胰腺假性囊肿（pancreatic pseudocyst，PPC）的治疗方法。 方法 对我院自2001年1月～2014年1月收治52例胰腺假性囊肿病例的临床资料进行回顾性分析，比较非手术治疗与手术治疗（内引流、外引流及经皮穿刺置管引流）的临床疗效，总结急性胰腺假性囊肿的最佳治疗方法。 结果 急性PPC非手术治疗19例，其中2例因治疗后无效改行内引流手术；17例患者近期治愈并随访观察，其中1例1.5年后并发结肠脾区梗阻行梗阻结肠及囊肿切除，1例于3年后合并区域性门脉高压症并脾大食管静脉曲张破裂出血行胰腺体尾脾切除+贲门周围血管离断术痊愈。急性PPC行内引流术25例，其中PPC-胃吻合术2例，PPC-十二肠吻合术1例，急性PPC-空肠Roux-en-Y吻合22例；急性PPC影像学引导下经皮穿刺置管引流术（percutaneous catheter drainage，PTCD）5例，其中1例拔管后复发改行内引流。急性PPC外引流术5例，4例痊愈，1例并发胰瘘行瘘管空肠内引流术。与非手术治疗相比，外科手术治疗的术后复发率较低，治疗效果理想；非手术治疗的远期并发症常需要后期的外科手术来治疗。 结论 胰腺假性囊肿的外科手术治疗对急性PPC的治疗效果确切，按照个体化治疗原则，值得临床推广。

[关键词] 胰腺；假性囊肿；置管；引流

[中图分类号] R657.5 [文献标识码] B [文章编号] 1673-9701（2017）26-0044-04

Surgical treatment of acute pancreatic pseudocyst

YANG Xiufeng BAI Huatian LV Ruiguang ZHANG Yewei CHEN Haowei SHE Zhanfei YANG Zhe

Department of General Surgery， Erdos School of Clinical Medicine， Inner Mongolia Medical University， Erdos Central Hospital， Erdos 017000， China

[Abstract] Objective To study the treatment of acute pancreatic pseudocyst（PPC）. Methods The clinical data of 52 cases of pancreatic pseudocysts who were admitted to our hospital from January 2001 to January 2014 were retrospectively analyzed. The clinical efficacy of non-surgical treatment and surgical treatment（internal drainage， external drainage and percutaneous catheter drainage） were compared. The best treatment for acute pancreatic pseudocyst was summarized. Results There were 19 cases receiving acute PPC non-surgical treatment， among whom 2 cases were given internal drainage due to ineffective treatment； 17 patients were recently cured and followed up for observation. Among them， 1 case was complicated with colon obstruction at spleen section and given resection of obstructed colon and cyst after 1.5 years. 1 case was complicated with regional portal hypertension combined with splenic esophageal variceal bleeding and given pancreatic gyrus resection+pericardial devascularization surgery after 3 years before being cured. 25 cases were given internal drainage due to acute PCC， among whom PPC-stomach anastomosis was in 2 cases， PPC-duodenostomy was in 1 case， acute PPC-jejunum Roux-en-Y anastomosis was in 22 cases； there were 5 cases receiving percutaneous catheter drainage（PTCD） guided by acute PPC imaging， among whom one case was given internal drainage due to recurrence after extubation. There were 5 cases receiving acute PPC external drainage. Among them， 4 cases were cured， and 1 case was complicated with pancreatic fistula and further given fistula jejunal internal drainage. Compared with non-surgical treatment， the postoperative recurrence rate was lower in surgical treatment， and the treatment effect was ideal； the long-term complications of non-surgical treatment often required surgical treatment in a later date. Conclusion The surgical treatment of pancreatic pseudocyst is effective in the treatment of acute PPC. In accordance with the principle of individual treatment， it is worthy of clinical promotion.endprint

[Key words] Pancreas； Pancreatic pseudocyst； Catheterization； Drainage

胰腺假性囊肿（pancreatic pseudocyst，PPC）是指由各种原因（急性胰腺炎、慢性胰腺炎、胰管梗阻及胰腺创伤等）导致的胰腺内或胰腺周围的异常物质（外漏的胰液、血液、坏死组织等）存留形成的囊腔，其囊壁由腹膜、网膜或炎性纤维组织构成，因其囊壁内无上皮细胞衬托故称之为假性囊肿[1]。……