Учёные записки Санкт-Петербургского государственного медицинского университета им. Акад. И.П. Павлова (Dec 2017)

TREATMENT OF PATIENTS WITH EXTERNAL PANCREATIC FISTULAS AFTER PERCUTANEOUS DRAINAGE INTERVENTIONS OF PANCREATIC PSEUDOCYSTS

  • D. Yu. Semenov,
  • A. A. Rebrov,
  • V. V. Vasil’yev,
  • A. A. Vaganov,
  • O. V. Poliglottov,
  • V. V. Baryshnikova,
  • А. P. Bogdanov,
  • Z. A. Gunya

DOI
https://doi.org/10.24884/1607-4181-2017-24-4-45-49
Journal volume & issue
Vol. 24, no. 4
pp. 45 – 49

Abstract

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Introduction. External pancreatic fistulas are developed up to 45 % during the postoperative period after the percutaneous drainage of pancreatic pseudocysts. According to some authors this fact is the main contraindication for using of transcutaneous method in treatment of these patients.The objective is to optimize the tactics of treatment for minimizing the possible development of external pancreatic fistulasMaterials and methods. Puncture-draining operations were performed in 164 patients with chronic pancreatic pseudocysts. Puncture operations with ultrasound control were primarily performed in 54 patients (32.9 %), they were effective for 29 patients (53.7 %). Traditional surgical interventions were performed in 7 patients (12.9 %) from this group. Percutaneous drainage of pseudocyst was secondary used in 18 patients (33.4 %). Percutaneous drainage of pseudocysts was primarily used in other group consisting of 110 (67.1 %) patients. During the postoperative period, external pancreatic fistula formed in 36 (32.7 %) patients from this group. The fistulas were eliminated by supplementing the transcutaneous interventions with endoscopic methods.Results. Endoscopic papillosphincterotomy was performed in 36 patients. Pancreatic fistulas were closed after the operation in 12 patients (33.3 %). Endoscopic formation cystogastro-, cystoduodenoanastomosis on «lost drainage» were performed in 9 patients (25 %). Temporary decompression transpapillary stenting of the MPD was performed in 15 patients (41.7 %), endoscopic retrograde stenting was performed in 5 of them. Antegrade stenting of the MPD was transcutaneously performed in 10 patients. There were no lethal outcomes. Fistulas regressed in all patients. Recurrence of cyst formation, pancreatic hypertension were not be to dynamic examinations. Algorithm of treatment was formed and based on the results of a retrospective analysis to treatment of pancreatic cysts in general surgical clinic of «Pavlov First Saint Petersburg State Medical University».Conclusions. Coherent combining of minimally invasive technologies in the treatment of patients with chronic pancreatic pseudocysts leads to good results: absolute cystic regression and elimination of pancreatic fistulas as appropriate.

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