- 期刊
巨大胰臟假性囊腫腹內引流手術致嚴重併發症與處置：病例報告及文獻回顧
Management of Severe Complication after Internal Drainage Surgery of Giant Pancreatic Pseudocyst: A Case Report and Literature Review
摘要
胰臟假性囊腫，通常在急性胰臟炎、慢性胰臟炎或胰臟外傷後產生。其併發症有感染、腸阻塞、破裂、出血，而以假性囊腫內出血或合併感染，是最爲嚴重的併發症，可能因此而導致死亡。根據假性囊腫大小和發育情形，其治療可採內科治療：保守治療、經皮抽吸術、經皮導管引流術、經胃視鏡引流術；外科治療：體外引流、囊腫胃吻合術、囊腫十二指腸吻合術、囊腫空腸吻合術、胰臟切除。本文報告一位42歲且長期酗酒的男性，於民國90年，在他院診斷出急性胰臟炎，並接受治療而順利出院，且停止喝酒。直到民國92年3月，因腹部鈍痛、食慾差、體重減輕6-7公斤，至住家附近醫院檢查，腹部超音波診斷爲脾腫大，並建議至本院門診做進一步評估。經由本院腹部超音波和電腦斷層掃瞄檢查，診斷爲巨大胰臟假性囊腫。根據理學和影像診斷，囊腫空腸吻合術是最佳的治療方式，於是接受囊腫空腸吻合術。在術後，陸續有併發症發生，因突發不穩定的血液動力學改變而引起心博過速和高血壓、胰臟膿瘍及深層靜脈血栓。對於突發不穩定的血液動力學改變而引起的心博過速和高血壓，將病患轉至加護病房以集中觀察治療；胰臟膿瘍，不斷更換不同口徑的導管，經由經皮導管引流術來引流；深層靜脈血塞，給予Urokinase治療，但未能改善，故安排血栓濾網置放術。於是，各種併發症逐一緩解，病患出院。在本院門診持續追蹤一段時間後，假性囊腫的症狀逐漸痊癒，沒有再復發情形。本文希望藉此病例報告討論，讓罹患巨大胰臟假性囊腫，在經腹內引流手術後，而導致胰臟膿瘍嚴重併發症的患者，能有所依循地來選擇最適合的治療方式。
並列摘要
Pseudocyst of pancreas usually follows the acute pancreatitis, chronic pancreatitis, and pancreatic injury. They may be complicated with infection, intestinal obstruction, bleeding and rupture. Among them, bleeding and infection are the most dangerous sequalae of the pancreatic pseudocyst. The treatment of such cyst includes medical treatment such as expectant therapy, percutaneous aspiration, percutaneous drainage, and endoscopic transgastric drainage. Surgical procedures include external drainage, cystogastrostomy, cystoduodenostomy, cystojejunostomy, and pancreatic resection. We here report a 42 years old alcoholic patient sustained acute pancreatitis in 2001 and was treated at other hospital. Two years later, he got abdominal distension, less appetite, and loss of body weight for about 6-7 kg in a few weeks. Abdominal sonographic examination and computed tomography, revealed a giant pseudocyst of pancreas. According to the physical examination and image study, cystojejunostomy is considered to be the best method for this patient. After operation, the complications was seen one after another including immediate postoperative complications such as high blood pressure, tachycardia, tachypnea due to abrupt hemodynamic change probably due to sudden release of the intraabdominal pressure, pancreatic abscess, and deep vein thrombosis. We used percuaneous drainage for pancreatic abscess and multiple wide bore tubes were used for effective drainage. The condition, however, improved with effective external drainage and no recurrence was noted after four years follow up.