Pancreatic pseudocyst resection and internal drainage

Pancreatic cysts are divided into two categories: true and false. True cysts are small in size, with envelopes, mostly located in the pancreas or pancreas, often without obvious symptoms, and do not require surgical treatment; pseudocysts are leaking pancreatic exudate when acute pancreatitis or pancreatic trauma, accumulate in small nets In the membrane cavity, the surrounding tissue is stimulated, causing fibrotic pseudomembrane, often due to volume expansion, gastrointestinal compression symptoms, and surgical treatment. Treating diseases: pancreatic cysts Indication 1. Appropriate time for pancreatic cyst surgery Any pseudocyst formed after inflammation and trauma should be operated after 3 to 6 months. If the time is shorter than 6 months, conservative treatment should be performed first to avoid the capsule wall being too thin during the anastomosis operation, so that the anastomosis leaks. 2. Pancreatic cyst resection of the pancreatic cyst, pancreatic or pancreatic resection, extracapsular drainage, etc., the application range is very small, and each has its own shortcomings, except for some true cysts can be removed, other should not be used. 3. There are three clinically used internal drainage of pancreatic cysts. (1) pancreatic cyst gastric anastomosis: located above the stomach, behind the stomach and close to the stomach wall cysts, should adopt this type of surgery. (2) pancreatic cyst duodenal anastomosis: located in the head of the pancreas or the wall of the capsule and the duodenal intestinal wall close to the cyst, should adopt this procedure. (3) pancreatic cyst jejunostomy: large and expansive in the omental cavity, as well as cysts located in the head of the pancreas but not close to the duodenal wall, this procedure should be adopted. Preoperative preparation The operation of drainage in pancreatic cysts is complicated, and such patients often affect nutrition due to limited eating. Therefore, the balance of water and electrolyte should be corrected before surgery, antibiotics should be used to prevent infection, and blood transfusion preparation should be done. The stomach can be washed on the eve of the operation, and the stomach tube is placed before surgery. Surgical procedure (a) pancreatic cyst gastric anastomosis 1. Position, incision: supine position. The upper midline incision or the transabdominal rectus incision is selected according to the specific location of the cyst. 2. Exploration: After entering the abdominal cavity, first determine the exact location of the pancreatic cyst, and make a diagnosis by puncture and drainage. At the same time, pay attention to the relationship between the cyst and the stomach and the colon and its mesentery. If the cyst is found above or below the stomach, the cystic anastomosis can be determined. 3. Cut the anterior wall of the stomach: make a longitudinal incision along the long axis of the anterior wall of the stomach, about 6 cm long. The muscle layer was first opened, and the branches of each submucosa were cut with a No. 1 silk thread under direct vision to prevent bleeding. 4. Intragastric exploration: open the anterior wall of the stomach with a small hook, carefully palpate the posterior wall of the gastric cavity, and then use the puncture of the pancreatic cyst to test the puncture for further confirmation. 5. Incision of the cyst through the posterior wall of the stomach: the posterior wall of the stomach and the anterior wall of the cyst are cut at the puncture needle hole, the fluid in the cyst is aspirated, the incision is enlarged, and the posterior wall tissue and the cyst wall of 3 cm × 2 cm are cut off. To ensure that the anastomosis is smooth. After careful hemostasis, insert a cyst with your finger and probe the wall to see if there are multiple cysts or malignant changes. 6. Stitching the anastomosis: the incision of the posterior wall of the stomach and the anterior wall of the cyst was sutured with a 0-gauge chromic gut. 7. Suture the anterior wall of the stomach: use the 1-0 silk thread as the full-thickness varus to suture the anterior wall of the stomach, and the outer layer of the sarcolemma to interrupt the vaginal suture. Generally, the abdominal cavity does not need to be drained, and the skin is sewed layer by layer. (two) pancreatic cyst duodenal anastomosis Take the right upper transabdominal rectus incision, after entering the abdominal cavity examination, first separate the colonic hepatic flexion, push it downward, and then separate the duodenal descending. The common bile duct was opened, and the biliary spon was placed to probe the relationship between the cyst and the common bile duct. The anterior wall of the duodenum was cut far from the duodenal papilla. After the puncture confirmed the cyst, avoid the common bile duct and its opening, and cut the intestinal wall and the wall of the duodenum and the cyst on the upper side or the lower side, and cut a piece of tissue of 3 cm × 1 cm. The posterior wall of the duodenum and the anastomosis of the cyst were sutured with a gut for a circle. The anterior wall of the duodenum was sutured horizontally. If the incision in the intestine wall is long, it can also be sutured longitudinally to avoid twisting into an angle. The common bile duct was placed in a t-shaped tube for drainage. After a soft rubber tube was placed near the duodenal incision, the abdominal wall was sutured layer by layer. (C) pancreatic cyst jejunostomy 1. Pancreatic cyst jejun roux-y anastomosis: This method can avoid food residue and gastrointestinal contents returning to the sac, and rarely secondary infection after surgery, is an ideal surgical procedure; It is safe to be fully prepared and implemented under certain technical conditions. The method is to cut the jejunum 15 to 20 cm away from the duodenal suspensory ligament, and to extend the distal segment to the end of the colon and the end of the cyst, and the proximal jejunum and the distal jejunum of the cyst jejunum are 30 to 35 cm away. The end-to-side anastomosis should be close to parallel, so that the angle is almost zero. 2. Pancreatic cyst jejun lateral anastomosis: This method is relatively simple and easy, and there is no ailment of intestinal bleeding. The method is to introduce the jejunum 30 cm away from the duodenal suspensory ligament to the transverse colon, and to perform the lateral anastomosis of the jejunum and the cyst. The proximal and distal jejunum are further anastomosed at a distance of 10 cm from the anastomosis.