【摘要】：目的:通過(guò)對(duì)胰腺假性囊腫患者病例的分析,旨在提高胰腺假性囊腫的診治水平。方法:回顧性分析2010年1月至2015年10月在弋磯山醫(yī)院明確診斷為胰腺假性囊腫的76例患者的性別、年齡、假性囊腫的部位和大小、病因、臨床表現(xiàn)、輔助檢查以及治療。結(jié)果:76例胰腺假性囊腫患者中男性有42例(55.3%),女性有34例(44.7%);最大年齡為78歲,最小年齡為19歲,平均年齡為(41.5±1.5)歲;有47例(61.8%)假性囊腫出現(xiàn)在胰腺體尾部,13例(17.1%)出現(xiàn)在胰頭,16例(21.1%)出現(xiàn)在胰腺尾部;假性囊腫最大直徑為18cm,最小直徑3.2cm,平均直徑(6.7±0.8)cm。胰腺假性囊腫的病因包括急性胰腺炎36例(47.4%),胰腺外傷10例(13.1%);胰腺手術(shù)4例(5.3%),不明原因3例(3.9%)。胰腺假性囊腫的臨床表現(xiàn)有腹痛66例(90.4%)、腹脹48例(63.2%)、惡心37例(48.7%)、嘔吐32例(42.1%)、黃疸14(18.4%)、畏寒發(fā)熱21例(27.6%)、納差27例(35.5%)、體重下降33例(43.3%)、腹膜炎4例(5.3%)、腹部包快59例(77.6%)、無(wú)癥狀7例(9.2%)。76例胰腺假性囊腫患者全部行血淀粉酶檢查,41例(53.9%)明顯升高,32例行囊液淀粉酶檢查,32例(100%)明顯升高。53例胰腺假性囊腫患者全部行CEA和CA19-9檢查,全部在正常值范圍內(nèi)。76例PPC患者全部行B超和CT檢查,B超陽(yáng)性檢出率為80.3%(61/76),CT陽(yáng)性檢出率為90.8%(69/76);32例行MRI檢查,陽(yáng)性檢出率為65.6%(21/32);45例行MRCP檢查,陽(yáng)性檢出率為86.7%(39/45);19例行ERCP檢查,陽(yáng)性檢出率為68.4%(13/19);8例行EUS檢查,陽(yáng)性檢出率為75%(6/8)。76例PPC患者中期待觀察治療13例,其中2例失訪,余11例隨訪3-6個(gè)月有8例假性囊腫自行消失,3例假性囊腫明顯縮小且無(wú)癥狀;保守治療24例,治愈20例;經(jīng)皮穿刺置管引流6例,均治愈;手術(shù)治療28例,其中外引流術(shù)3例、均治愈,內(nèi)引流術(shù)23例、治愈22例(囊腫胃吻合術(shù)5例,均治愈;囊腫十二指腸吻合術(shù)2例,均治愈;囊腫空腸Roux-en-Y型吻合術(shù)16例,治愈15例,1例復(fù)發(fā)),囊腫切除術(shù)2例、均治愈;超聲內(nèi)鏡下經(jīng)胃引流術(shù)5例,均治愈。結(jié)論:(1)PPC無(wú)性別差異。(2)PPC多見(jiàn)于中年(30-50)歲。(3)PPC多發(fā)生于胰腺體尾部。(4)PPC最常見(jiàn)的病因?yàn)榧毙砸认傺住?5)PPC患者臨床表現(xiàn)無(wú)特異性,診斷主要依據(jù)影像學(xué)檢查。(6)B超可以作為診斷胰PPC的首選方法,CT檢查是診斷PPC最準(zhǔn)確的方法。(7)PPC的治療依賴于假性囊腫的大小、部位、有無(wú)并發(fā)癥及基礎(chǔ)疾病等多種因素,宜采取個(gè)體化原則。
[Abstract]:Objective: to improve the diagnosis and treatment of pancreatic pseudocyst by analyzing the cases of pancreatic pseudocyst. Methods: the sex, age, location and size, etiology, clinical manifestation, adjuvant examination and treatment of 76 patients with pancreatic pseudocyst were analyzed retrospectively from January 2010 to October 2015. Results: there were 42 males (55.3%) and 34 females (44.7%) in 76 patients with pancreatic pseudocyst, the maximum age was 78 years old, the minimum age was 19 years old, the average age was (41.5 鹵1.5) years old. There were 47 (61.8%) pseudocysts in the pancreatic body and tail, 13 (17.1%) in the pancreatic head and 16 (21.1%) in the pancreatic tail. The maximum diameter of pseudocyst was 18 cm, the minimum diameter was 3.2 cm, and the mean diameter was (6.7 鹵0.8) cm.. The etiology of pancreatic pseudocyst included acute pancreatitis in 36 cases (47.4%), pancreatic trauma in 10 cases (13.1%), pancreatic surgery in 4 cases (5.3%) and unknown cause in 3 cases (3.9%). The clinical manifestations of pancreatic pseudocyst included abdominal pain in 66 cases (90.4%), abdominal distension in 48 cases (63.2%), nausea in 37 cases (48.7%), vomiting in 32 cases (42.1%), jaundice in 14 cases (18.4%), chilling fever in 21 cases (27.6%), anorexia in 27 cases (35.5%), weight loss in 33 cases (43.3%), peritonitis in 4 cases (5.3%), abdominal rapid wrapping in 59 cases (77.6%), asymptomatic. All 76 cases of pancreatic pseudocyst were examined with serum amylase, 41 cases (53.9%) were significantly elevated, 32 cases (100%) of pancreatic pseudocyst were examined by amylase, and 53 cases of pancreatic pseudocyst were examined by CEA and CA19-9. The positive rate of B ultrasound and CT was 80.3% (61 / 76) in all patients with PPC, 90.8% (69 / 76) with MRI, 65.6% (21 / 32) with MRI, 86.7% (39 / 45) with MRCP and 19 with ERCP. The positive rate of EUS was 68.4% (13 / 19), and the positive rate was 75% (6 / 8) in 8 cases of PPC. Among the 76 cases of PPC, 13 cases were expected to be treated by observation, 2 cases were lost, 8 cases of pseudocyst disappeared and 3 cases of pseudocyst disappeared, and 3 cases of pseudocyst were obviously reduced and asymptomatic. 24 cases were treated conservatively, 20 cases were cured, 6 cases were cured by percutaneous catheterization, 28 cases were cured by operation, 3 cases were cured by external drainage, 23 cases were cured by internal drainage, 22 cases were cured (5 cases of cyst-stomach anastomosis). Cyst-duodenostomy (n = 2), cyst-jejunostomy (n = 16), jejunostomy (n = 15), cystectomy (n = 2) and endoscopic transgastric drainage (n = 5) were all cured. Conclusion: (1) there is no sex difference in PPC. (2) PPC is more common in middle age (30-50) years old. (3) PPC mostly occurs in the pancreatic body and tail. (4) the most common cause of PPC is acute pancreatitis. (5) the clinical manifestations of PPC patients are not specific. The diagnosis is mainly based on imaging examination. (6) B-ultrasound can be used as the first choice in diagnosing pancreatic PPC, and CT is the most accurate method in diagnosing PPC. (7) the treatment of PPC depends on the size and location of pseudocysts, whether there are complications and underlying diseases, and so on. The principle of individualization should be adopted.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R657.5

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