Diagnosis and Treatment of Rupture of Pancreatic Cystic Disease (Report of 20 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENHong-ze ,  SUNBei , CHENHua , BAIXue-wei , KONGRui , LILe

Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China;

Corresponding author：

SUNBei, Email: sunbei70@tom.com

Keywords：

Pancreatic pseudocyst; Pancreatic cystic neoplasm; rupture; Individual therapy

DOI：

10.7507/1007-9424.20160244

Video：

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Objective To investigate diagnosis and treatment of rupture of pancreatic cystic disease. Method The clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively. Results ① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken. Conclusions How to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.

Citation： CHENHong-ze, SUNBei, CHENHua, BAIXue-wei, KONGRui, LILe. Diagnosis and Treatment of Rupture of Pancreatic Cystic Disease (Report of 20 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(8): 931-935. doi: 10.7507/1007-9424.20160244 Copy

1.	Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol, 2015, 6(4):375-388.
2.	Jana T, Shroff J, Bhutani MS. Pancreatic cystic neoplasms:Review of current knowledge, diagnostic challenges, and management options. J Carcinog, 2015, 14:3.
3.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
4.	Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH):an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1):20-25.
5.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery:a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5):761-768.
6.	中华医学会外科学分会胰腺外科学组.胰腺囊性疾病诊治指南(2015), 2015, 35(9):955-959.
7.	李骥, 王晓乙, 傅德良, 等.胰腺囊性病变161例外科诊治分析.中国实用外科杂志, 2013, 33(6):493-496.
8.	Packeisen J, Klingen D, Grezella F. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Z Gastroenterol, 2001, 39(11):961-964.
9.	Takamatsu S, Nagano H, Ohtsukasa S, et al. A case of spontaneous ruptured solid pseudopapillary tumor of pancreas resected by laparoscopic surgery. Case Rep Med, 2013, 2013:953240.
10.	Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas:a 33-year experience at the Massachusetts General Hospital. Surgery, 2012, 152(3 suppl 1):S4-S12.
11.	Sahani DV, Kadavigere R, Saokar A, et al. Cystic pancreatic lesions:a simple imaging-based classification system for guiding management. Radiographics, 2005, 25(6):1471-1484.
12.	Macari M, Finn ME, Bennett GL, et al. Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging:value of perceived internal debris. Radiology, 2009, 251(1):77-84.
13.	王春友.胰腺囊腺瘤恶变.中国实用外科杂志, 2009, 29(8):780-782.
14.	赵玉沛.重视胰腺良性肿瘤的诊断和治疗.中国实用外科杂志, 2008, 28(5):333-335.
15.	Lerch MM, Stier A, Wahnschaffe U, et al. Pancreatic pseudocysts:observation, endoscopic drainage, or resection? Dtsch Arztebl Int, 2009, 106(38):614-621.
16.	Farrell JJ. Prevalence, diagnosis and management of pancreatic cystic neoplasms:current status and future directions. Gut Liver, 2015, 9(5):571-589.
17.	杨尹默, 王君.胰腺囊性肿瘤诊治中的几个热点与难点问题.中国实用外科杂志, 2013, 33(6):438-442.
18.	郝建朋, 姚俊超, 郭大伟, 等.胰腺囊性肿瘤19例诊治分析.中国普外基础与临床杂志, 2013, 20(11):1295-1297.
19.	Rotellar F, Pardo F, Benito A, et al. Laparoscopic resection of the uncinate process of the pancreas:the inframesocolic approach and hanging maneuver of the mesenteric root. Surg Endosc, 2011, 25(10):3426-3427.
20.	Brient C, Regenet N, Sulpice L, et al. Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J Gastrointest Surg, 2012, 16(10):1883-1887.
21.	蒋奎荣, 吴鹏飞, 苗毅.胰腺假性囊肿诊治进展.中国实用外科杂志, 2013, 33(6):511-514.
22.	Morton JM, Brown A, Galanko JA, et al. A national comparison of surgical versus percutaneous drainage of pancreatic pseudocysts:1997-2001. J Gastrointest Surg, 2005, 9(1):15-20.
23.	元海成, 秦鸣放.胰腺假性囊肿内镜及腹腔镜个体化治疗68例分析.中国实用外科杂志, 2013, 33(5):404-406.
24.	Andersson B, Nilsson E, Willner J, et al. Treatment and outcome in pancreatic pseudocysts. Scand J Gastroenterol, 2006, 41(6):751-756.
25.	Nealon WH, Walser E. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg, 2005, 241(6):948-957.

1. Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol, 2015, 6(4):375-388.
2. Jana T, Shroff J, Bhutani MS. Pancreatic cystic neoplasms:Review of current knowledge, diagnostic challenges, and management options. J Carcinog, 2015, 14:3.
3. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition. Surgery, 2005, 138(1):8-13.
4. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH):an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1):20-25.
5. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery:a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5):761-768.
6. 中华医学会外科学分会胰腺外科学组.胰腺囊性疾病诊治指南(2015), 2015, 35(9):955-959.
7. 李骥, 王晓乙, 傅德良, 等.胰腺囊性病变161例外科诊治分析.中国实用外科杂志, 2013, 33(6):493-496.
8. Packeisen J, Klingen D, Grezella F. Spontaneous rupture of a pancreatic pseudocyst into the portal vein. Z Gastroenterol, 2001, 39(11):961-964.
9. Takamatsu S, Nagano H, Ohtsukasa S, et al. A case of spontaneous ruptured solid pseudopapillary tumor of pancreas resected by laparoscopic surgery. Case Rep Med, 2013, 2013:953240.
10. Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas:a 33-year experience at the Massachusetts General Hospital. Surgery, 2012, 152(3 suppl 1):S4-S12.
11. Sahani DV, Kadavigere R, Saokar A, et al. Cystic pancreatic lesions:a simple imaging-based classification system for guiding management. Radiographics, 2005, 25(6):1471-1484.
12. Macari M, Finn ME, Bennett GL, et al. Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging:value of perceived internal debris. Radiology, 2009, 251(1):77-84.
13. 王春友.胰腺囊腺瘤恶变.中国实用外科杂志, 2009, 29(8):780-782.
14. 赵玉沛.重视胰腺良性肿瘤的诊断和治疗.中国实用外科杂志, 2008, 28(5):333-335.
15. Lerch MM, Stier A, Wahnschaffe U, et al. Pancreatic pseudocysts:observation, endoscopic drainage, or resection? Dtsch Arztebl Int, 2009, 106(38):614-621.
16. Farrell JJ. Prevalence, diagnosis and management of pancreatic cystic neoplasms:current status and future directions. Gut Liver, 2015, 9(5):571-589.
17. 杨尹默, 王君.胰腺囊性肿瘤诊治中的几个热点与难点问题.中国实用外科杂志, 2013, 33(6):438-442.
18. 郝建朋, 姚俊超, 郭大伟, 等.胰腺囊性肿瘤19例诊治分析.中国普外基础与临床杂志, 2013, 20(11):1295-1297.
19. Rotellar F, Pardo F, Benito A, et al. Laparoscopic resection of the uncinate process of the pancreas:the inframesocolic approach and hanging maneuver of the mesenteric root. Surg Endosc, 2011, 25(10):3426-3427.
20. Brient C, Regenet N, Sulpice L, et al. Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J Gastrointest Surg, 2012, 16(10):1883-1887.
21. 蒋奎荣, 吴鹏飞, 苗毅.胰腺假性囊肿诊治进展.中国实用外科杂志, 2013, 33(6):511-514.
22. Morton JM, Brown A, Galanko JA, et al. A national comparison of surgical versus percutaneous drainage of pancreatic pseudocysts:1997-2001. J Gastrointest Surg, 2005, 9(1):15-20.
23. 元海成, 秦鸣放.胰腺假性囊肿内镜及腹腔镜个体化治疗68例分析.中国实用外科杂志, 2013, 33(5):404-406.
24. Andersson B, Nilsson E, Willner J, et al. Treatment and outcome in pancreatic pseudocysts. Scand J Gastroenterol, 2006, 41(6):751-756.
25. Nealon WH, Walser E. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg, 2005, 241(6):948-957.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment of Rupture of Pancreatic Cystic Disease (Report of 20 Cases)

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