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.	中華醫學會外科學分會胰腺外科學組.胰腺囊性疾病診治指南(2015), 2015, 35(9):955-959.
7.	李驥, 王曉乙, 傅德良, 等.胰腺囊性病變161例外科診治分析.中國實用外科雜志, 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.胰腺囊腺瘤惡變.中國實用外科雜志, 2009, 29(8):780-782.
14.	趙玉沛.重視胰腺良性腫瘤的診斷和治療.中國實用外科雜志, 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.	楊尹默, 王君.胰腺囊性腫瘤診治中的幾個熱點與難點問題.中國實用外科雜志, 2013, 33(6):438-442.
18.	郝建朋, 姚俊超, 郭大偉, 等.胰腺囊性腫瘤19例診治分析.中國普外基礎與臨床雜志, 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.	蔣奎榮, 吳鵬飛, 苗毅.胰腺假性囊腫診治進展.中國實用外科雜志, 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, 秦鳴放.胰腺假性囊腫內鏡及腹腔鏡個體化治療68例分析.中國實用外科雜志, 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. 中華醫學會外科學分會胰腺外科學組.胰腺囊性疾病診治指南(2015), 2015, 35(9):955-959.
7. 李驥, 王曉乙, 傅德良, 等.胰腺囊性病變161例外科診治分析.中國實用外科雜志, 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.胰腺囊腺瘤惡變.中國實用外科雜志, 2009, 29(8):780-782.
14. 趙玉沛.重視胰腺良性腫瘤的診斷和治療.中國實用外科雜志, 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. 楊尹默, 王君.胰腺囊性腫瘤診治中的幾個熱點與難點問題.中國實用外科雜志, 2013, 33(6):438-442.
18. 郝建朋, 姚俊超, 郭大偉, 等.胰腺囊性腫瘤19例診治分析.中國普外基礎與臨床雜志, 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. 蔣奎榮, 吳鵬飛, 苗毅.胰腺假性囊腫診治進展.中國實用外科雜志, 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, 秦鳴放.胰腺假性囊腫內鏡及腹腔鏡個體化治療68例分析.中國實用外科雜志, 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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