Interventional Ultrasound Combined with Endoscopic Technique Sequentially Minimally Invasive Treatment for Aged and High Risk Symptomatic Pancreatic Pseudocyst_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Hui ,  WANG Tao , TANG Lijun , CHEN Qi , JIANG Zongxing , LU Yaling

Center of General Surgery， Chengdu Military Region General Hospital， Chengdu 610083， Sichuan Province， China;

Corresponding author：

WANG Tao, Email: watopo@163.com

Keywords：

Interventional ultrasound; Endoscopic technique; Pancreatic pseudocyst; Aged and high risk

Video：

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Objective 　To summarize the experience of sequentially minimally invasive treatment for aged and high risk symptomatic pancreatic pseudocyst under ultrasound guided percutaneous catheter drainage combined with endoscopic technique.
Methods 　The clinical data of 30 patients with aged and high risk pancreatic pseudocyst treated from January 2009 to January 2012 in this hospital were analyzed retrospectively.
Results 　Percutaneous tubes were successfully placed in 30 patients， cystic liquid was sufficiently drained， and the compression symptom of cyst was relieved immediately. After stable disease， 12 patients with communicating cysts were diagnosed by using endoscopic retrograde cholangiopancreatography. Pancreatic duct stents were inserted in 12 patients with communicating cysts for 60-90d （with an average 70d） after endoscopic sphincterectomy and endoscopic pancreatic sphincterectomy. Cysts disappeared in the other 18 cases receiving external drainage with external drainage tubes， the drainage time was 15-90 d with an average 30d. Neither recurrence nor complications were found in all the cases during 12-21 months （with an average 18 months） follow-up.
Conclusion 　Interventional ultrasound combined with endoscopic technique sequentially minimally invasive treatment for aged and high risk symptomatic pancreatic pseudocyst has superiorities in little trauma， fewer complications， and exact effect.

Citation： ZHANG Hui,WANG Tao,TANG Lijun,CHEN Qi,JIANG Zongxing,LU Yaling. Interventional Ultrasound Combined with Endoscopic Technique Sequentially Minimally Invasive Treatment for Aged and High Risk Symptomatic Pancreatic Pseudocyst. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(2): 191-194. doi: Copy

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2.	王刚，孙备，姜洪池. 高脂血症急性胰腺炎的研究进展[J]. 中国普通外科杂志， 2005， 14(11)：857-859.
3.	Bhasin DK， Rana SS， Rao C， et al. Endoscopic management of pancreatic injury due to abdominal trauma[J]. JOP， 2012， 13(2)：187-192.
4.	刘天锡，方登华，高瑞岗，等. 胰腺假性囊肿57例诊治分析[J]. 肝胆外科杂志， 2009， 17(5)：369-371.
5.	Nealon WH， Walser E. Main pancreatic ductal anatomy candirect choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage)[J]. Ann Surg， 2002， 235(6)：751-758.
6.	黎珉，张宁，李雪爽. 假性胰腺囊肿的外科治疗[J]. 肝胆胰外科杂志， 2004， 16(4)：309-310.
7.	魏华，丁勇，孔燕，等. 超声引导经皮置管引流治疗小儿早期症状性胰腺假性囊肿[J]. 实用儿科临床杂志， 2011， 26(7)：542-544.
8.	Richter HM. Natural history of pancreatic pseudocysts//Howard J， Idezuki Y， Ihse I， et al， eds. Surgical diseases of the pancreas[M]. Baltimore：Williams and Wilkins， 1998：417-421.
9.	Giovannini M. Endoscopic ultrasonography-guided pancreatic drainage[J]. Gastrointest Endosc Clin N Am， 2012， 22(2)：221-230.
10.	Dubravcsik Z， Hritz I， Fejes R， et al. Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis：better overall outcome with adequate pancreatic drainage[J]. Scand J Gastroenterol， 2012， 47(6)：729-736.
11.	毛文锦，徐维，陶强，等. 儿童胰腺假性囊肿的诊断与治疗方法评估[J]. 临床小儿外科杂志， 2002， 1(6)：401-403.
12.	Weckman L， Kylänpää ML， Puolakkainen P， et al. Endoscopic treatment of pancreatic pseudocysts[J]. Surg Endosc， 2006， 20(4)：603-607.
13.	Cahen D， Rauws E， Fockens P， et al. Endoscopic drainage of pancreatic pseudocysts：long-term outcome and procedural factors associated with safe and successful treatment[J]. Endoscopy， 2005， 37(10)：977-983.
14.	Geoffrey CN， Rosenberg M， Rachel YC， et al. Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis：a nationwide， population-based study[J]. Gastrointest Endosc， 2012， 75(1)：47-55.
15.	Tarantino I， Di Pisa M， Barresi L， et al. Covered self expandable metallic stent with flared plastic one inside for pancreatic pseudocyst avoiding stent dislodgement[J]. World J Gastrointest Endosc， 2012， 4(4)：148-150.
16.	Nici AJ， Hussain SA， Kim SH， et al. Unique usage of a partially covered metal stent for drainage of a pancreatic pseudocyst via endosonography-guided transcystgastrostomy[J]. Dig Endosc， 2012， 24(3)：185-187.
17.	金安琴，黄晓俊，王伟，等. 早期内镜治疗急性胆源性胰腺炎46例临床研究[J]. 中国普外基础与临床杂志， 2010， 17(10)：1001-1005.
18.	Rasmussen DN， Hassan H， Vilmann P. Only few severe complications after endoscopic ultrasound guided drainage of pancreatic pseudocysts[J]. Dan Med J， 2012， 59(4)：A4406.
19.	Chen J， Fukami N， Li Z. Endoscopic approach to pancreatic pseudocyst， abscess and necrosis：review on recent progress[J]. Dig Endosc， 2012， 24(5)：299-308.
20.	Kraft M， Simon P， Nitsche C， et al. Successful drainage ofrecurrent pancreatic pseudocyst via a transpapillary and transpancreatic approach， using a conventional cystotome[J]. Endoscopy， 2012， 44 Suppl 2 UCTN：E186-E187.
21.	陈涛，张炳印，汤礼军，等. 治疗性ERCP术后相关并发症的防治[J]. 中国普通外科杂志， 2011， 20(3)：245-248.
22.	Freeman ML， DiSario JA， Nelson DB， et al. Risk factors for post-ERCP pancreatitis：a prospective， multicenter study[J]. Gastrointest Endosc， 2001， 54(4)：425-434.
23.	Das A， Singh P， Michael VJ， et al. Pancreatic-stent placement for prevention of post-ERCP pancreatitis：a cost-effectiveness analysis[J]. Gastrointest Endosc， 2007， 65(7)：960-968.
24.	Cennamo V， Fuccio L， Zagari RM， et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials[J]. Endoscopy， 2010， 42(5)：381-388.
25.	Petrov MS， Savides TJ. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis[J]. Br J Surg， 2009， 96(9)：967-974.
26.	马洪，肖丽达，张广俊，等. 超声引导内镜在梗阻性黄疸诊治中的应用研究[J]. 广西医科大学学报， 2010， 27(3)：397-399.

1. 郑本波，刘山，阳勇. 复发性急性胰腺炎的临床特点及其常见病因分析[J]. 中国普外基础与临床杂志， 2012， 19(10)：1102-1104.
2. 王刚，孙备，姜洪池. 高脂血症急性胰腺炎的研究进展[J]. 中国普通外科杂志， 2005， 14(11)：857-859.
3. Bhasin DK， Rana SS， Rao C， et al. Endoscopic management of pancreatic injury due to abdominal trauma[J]. JOP， 2012， 13(2)：187-192.
4. 刘天锡，方登华，高瑞岗，等. 胰腺假性囊肿57例诊治分析[J]. 肝胆外科杂志， 2009， 17(5)：369-371.
5. Nealon WH， Walser E. Main pancreatic ductal anatomy candirect choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage)[J]. Ann Surg， 2002， 235(6)：751-758.
6. 黎珉，张宁，李雪爽. 假性胰腺囊肿的外科治疗[J]. 肝胆胰外科杂志， 2004， 16(4)：309-310.
7. 魏华，丁勇，孔燕，等. 超声引导经皮置管引流治疗小儿早期症状性胰腺假性囊肿[J]. 实用儿科临床杂志， 2011， 26(7)：542-544.
8. Richter HM. Natural history of pancreatic pseudocysts//Howard J， Idezuki Y， Ihse I， et al， eds. Surgical diseases of the pancreas[M]. Baltimore：Williams and Wilkins， 1998：417-421.
9. Giovannini M. Endoscopic ultrasonography-guided pancreatic drainage[J]. Gastrointest Endosc Clin N Am， 2012， 22(2)：221-230.
10. Dubravcsik Z， Hritz I， Fejes R， et al. Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis：better overall outcome with adequate pancreatic drainage[J]. Scand J Gastroenterol， 2012， 47(6)：729-736.
11. 毛文锦，徐维，陶强，等. 儿童胰腺假性囊肿的诊断与治疗方法评估[J]. 临床小儿外科杂志， 2002， 1(6)：401-403.
12. Weckman L， Kylänpää ML， Puolakkainen P， et al. Endoscopic treatment of pancreatic pseudocysts[J]. Surg Endosc， 2006， 20(4)：603-607.
13. Cahen D， Rauws E， Fockens P， et al. Endoscopic drainage of pancreatic pseudocysts：long-term outcome and procedural factors associated with safe and successful treatment[J]. Endoscopy， 2005， 37(10)：977-983.
14. Geoffrey CN， Rosenberg M， Rachel YC， et al. Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis：a nationwide， population-based study[J]. Gastrointest Endosc， 2012， 75(1)：47-55.
15. Tarantino I， Di Pisa M， Barresi L， et al. Covered self expandable metallic stent with flared plastic one inside for pancreatic pseudocyst avoiding stent dislodgement[J]. World J Gastrointest Endosc， 2012， 4(4)：148-150.
16. Nici AJ， Hussain SA， Kim SH， et al. Unique usage of a partially covered metal stent for drainage of a pancreatic pseudocyst via endosonography-guided transcystgastrostomy[J]. Dig Endosc， 2012， 24(3)：185-187.
17. 金安琴，黄晓俊，王伟，等. 早期内镜治疗急性胆源性胰腺炎46例临床研究[J]. 中国普外基础与临床杂志， 2010， 17(10)：1001-1005.
18. Rasmussen DN， Hassan H， Vilmann P. Only few severe complications after endoscopic ultrasound guided drainage of pancreatic pseudocysts[J]. Dan Med J， 2012， 59(4)：A4406.
19. Chen J， Fukami N， Li Z. Endoscopic approach to pancreatic pseudocyst， abscess and necrosis：review on recent progress[J]. Dig Endosc， 2012， 24(5)：299-308.
20. Kraft M， Simon P， Nitsche C， et al. Successful drainage ofrecurrent pancreatic pseudocyst via a transpapillary and transpancreatic approach， using a conventional cystotome[J]. Endoscopy， 2012， 44 Suppl 2 UCTN：E186-E187.
21. 陈涛，张炳印，汤礼军，等. 治疗性ERCP术后相关并发症的防治[J]. 中国普通外科杂志， 2011， 20(3)：245-248.
22. Freeman ML， DiSario JA， Nelson DB， et al. Risk factors for post-ERCP pancreatitis：a prospective， multicenter study[J]. Gastrointest Endosc， 2001， 54(4)：425-434.
23. Das A， Singh P， Michael VJ， et al. Pancreatic-stent placement for prevention of post-ERCP pancreatitis：a cost-effectiveness analysis[J]. Gastrointest Endosc， 2007， 65(7)：960-968.
24. Cennamo V， Fuccio L， Zagari RM， et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials[J]. Endoscopy， 2010， 42(5)：381-388.
25. Petrov MS， Savides TJ. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis[J]. Br J Surg， 2009， 96(9)：967-974.
26. 马洪，肖丽达，张广俊，等. 超声引导内镜在梗阻性黄疸诊治中的应用研究[J]. 广西医科大学学报， 2010， 27(3)：397-399.

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Interventional Ultrasound Combined with Endoscopic Technique Sequentially Minimally Invasive Treatment for Aged and High Risk Symptomatic Pancreatic Pseudocyst

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