76例胰腺假性囊肿临床特征的回顾性分析

发布时间：2018-10-12 07:17

【摘要】：目的:通过对胰腺假性囊肿患者病例的分析,旨在提高胰腺假性囊肿的诊治水平。方法:回顾性分析2010年1月至2015年10月在弋矶山医院明确诊断为胰腺假性囊肿的76例患者的性别、年龄、假性囊肿的部位和大小、病因、临床表现、辅助检查以及治疗。结果:76例胰腺假性囊肿患者中男性有42例(55.3%),女性有34例(44.7%);最大年龄为78岁,最小年龄为19岁,平均年龄为(41.5±1.5)岁;有47例(61.8%)假性囊肿出现在胰腺体尾部,13例(17.1%)出现在胰头,16例(21.1%)出现在胰腺尾部;假性囊肿最大直径为18cm,最小直径3.2cm,平均直径(6.7±0.8)cm。胰腺假性囊肿的病因包括急性胰腺炎36例(47.4%),胰腺外伤10例(13.1%);胰腺手术4例(5.3%),不明原因3例(3.9%)。胰腺假性囊肿的临床表现有腹痛66例(90.4%)、腹胀48例(63.2%)、恶心37例(48.7%)、呕吐32例(42.1%)、黄疸14(18.4%)、畏寒发热21例(27.6%)、纳差27例(35.5%)、体重下降33例(43.3%)、腹膜炎4例(5.3%)、腹部包快59例(77.6%)、无症状7例(9.2%)。76例胰腺假性囊肿患者全部行血淀粉酶检查,41例(53.9%)明显升高,32例行囊液淀粉酶检查,32例(100%)明显升高。53例胰腺假性囊肿患者全部行CEA和CA19-9检查,全部在正常值范围内。76例PPC患者全部行B超和CT检查,B超阳性检出率为80.3%(61/76),CT阳性检出率为90.8%(69/76);32例行MRI检查,阳性检出率为65.6%(21/32);45例行MRCP检查,阳性检出率为86.7%(39/45);19例行ERCP检查,阳性检出率为68.4%(13/19);8例行EUS检查,阳性检出率为75%(6/8)。76例PPC患者中期待观察治疗13例,其中2例失访,余11例随访3-6个月有8例假性囊肿自行消失,3例假性囊肿明显缩小且无症状;保守治疗24例,治愈20例;经皮穿刺置管引流6例,均治愈;手术治疗28例,其中外引流术3例、均治愈,内引流术23例、治愈22例(囊肿胃吻合术5例,均治愈;囊肿十二指肠吻合术2例,均治愈;囊肿空肠Roux-en-Y型吻合术16例,治愈15例,1例复发),囊肿切除术2例、均治愈;超声内镜下经胃引流术5例,均治愈。结论:(1)PPC无性别差异。(2)PPC多见于中年(30-50)岁。(3)PPC多发生于胰腺体尾部。(4)PPC最常见的病因为急性胰腺炎。(5)PPC患者临床表现无特异性,诊断主要依据影像学检查。(6)B超可以作为诊断胰PPC的首选方法,CT检查是诊断PPC最准确的方法。(7)PPC的治疗依赖于假性囊肿的大小、部位、有无并发症及基础疾病等多种因素,宜采取个体化原则。
[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 卤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 卤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.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.5

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