Management of Pancreatic Pseudocysts
| Autor: | John R. Galloway, William S. Richardson, Gene D. Branum, J. G. Hunter, J Richard Amerson, Hadar Spivak, Richard D Redvanly, J Patrick Waring, Aaron S. Fink, Susan J. Mauren |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male medicine.medical_specialty Percutaneous Pancreatic disease Pancreatic pseudocyst medicine.medical_treatment Secondary infection Peritonitis Radiography Interventional Cystectomy Pancreatectomy Recurrence Cause of Death Surveys and Questionnaires Pancreatic Pseudocyst medicine Humans Longitudinal Studies Abscess Aged Retrospective Studies Aged 80 and over business.industry Standard treatment Stomach Bacterial Infections Length of Stay Middle Aged medicine.disease Telephone Surgery Jejunum Treatment Outcome Debridement Disease Progression Drainage Female Tomography X-Ray Computed business Follow-Up Studies |
| Zdroj: | Journal of the American College of Surgeons. 186:507-511 |
| ISSN: | 1072-7515 |
| Popis: | Background: Operative internal drainage has been standard treatment for chronic unresolved pancreatic pseudocysts (PPs). Recently, percutaneous external drainage (PED) has become the primary mode of treatment at many medical centers. Study Design: A retrospective chart review was performed of 96 patients with PPs who were managed between 1987 and 1996. Longterm followup information was obtained by telephone and mail questionnaire. Results: Twenty-seven patients underwent computed tomographic (CT)-guided PED. PP resolution occurred in 17 patients. Clinical deterioration or secondary infection mandated urgent pancreatic debridement in 7 (26%) patients and cystgastrostomy in 2 (7%) patients. There was one hospital death in this group. Thirty-two patients underwent cystgastrostomy or cystjejunostomy (n = 21), distal pancreatectomy (n = 8), pancreatic debridement and external drainage (n = 2), or cystectomy (n = 1). Two (6%) patients required postoperative pancreatic debridement for failure of resolution and peritonitis and two patients underwent PED of abscess. There was one hospital death in the expectantly managed group of 37 patients. Median followup of 3 years (range, 0.5–9.3 years) in 66 patients revealed that 6, 3, and 4 patients of PED, surgery, and expectantly managed groups, respectively, had radiologic evidence of recurrent PPs. Conclusions: Operative management for PPs appears to be superior to CT-guided PED. Although the later was often successful, it required major salvage procedures in one third of the patients. An expectant management protocol may be suitable for selected patients. |
| Databáze: | OpenAIRE |
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