Endoscopic Ultrasonography-guided Puncture Drainage By Stomach In The Treatment Of Pancreatic Pseudocyst

Background:Treatment of pancreatic pseudocyst under Endoscopic Ultrasonography-guided (Eus) had the characteristics of small wounds,effective,low complication rate,which was the part of the technical development of natural orifice transluminal endoscopic surgery.It occupied an important position in the domestic treatment of pancreatic pseudocysts(PPC) field.However,Endoscopic Ultrasonography guided treatment of PPC still faced many disputes and problems,for example,how to decide the puncture time,how to choose the way of puncture drainage,how to postoperative the bracket out time and so on. Objective:Comparing patients with different treatment under Eus-guided therapy approach PPC,assessed the effect of endoscopic treatment of patients,and evaluated for the current controversial endoscopic therapy for patients with PPC timing,stent lifetime,whether placed nasal irrigation tube problems,which provided the feasibility of standardized treatment regimens for the future treatment of patients with PPC.Method:Reviewed eighty-four patients of PPC after acute pancreatitis in Minimally Invasive Center in Tianjin were enrolled to the study from December2011to October2013.To select patients in accordance with the Alexander’s standard of the definition by CT images which revision in2009.According to the different puncture time were randomly divided into two groups,namely Group A22cases and Group B62cases. According to the different therapeutic regimen,Group B was divided into three groups,Group Bl23cases,Group B224cases, Group B315cases, Group A and B,Group B1and B2,Group B1and B3were compared in patients with postoperative cyst fluid culture results, imaging changes(4w,8w,12w),body temperature(24h,72h,lw,2w), amylase(24h,72h,lw,2w), blood routine examination (24h,72h,lw,2w), liver function (72h,lw,2ws,4w)and other indicators,and in order to evaluate patient outcomes.Result: Group A:4cases were positive in fluid culture,8cases of patients after72h urine amylase were still high,6cases of patients after72h, temperature and blood picturewere still high, All cysts reduced in postoperative4weeks CT examination,and postoperative12weeks,including16cases with cyst disappeared,6cases with cyst decreased.Group B:12cases were positive in fluid culture,11cases of patients after72h urine amylase were still high,8cases of patients after72h, temperature and blood picturewere still high.All cysts reduced in postoperative4weeks CT examination,and postoperative12weeks weeks,including18cases with cyst disappeared,4cases with cyst decreased.Group B1:5cases were positive in fluid culture,4cases of patients after72h urine amylase were still high,4cases of patients after72h, temperature and blood picturewere still high.All patients drew double pigtail stents after8weeks,including4stents disappeared,2stents blocked,1case stent displaced.Cysts of23cases reduced in postoperative4weeks CT examination,and postoperative12weeks,including17cases with cyst disappeared,6cases with cyst decreased.Group B2:4cases were positive in fluid culture,3cases of patients after72h urine amylase were still high,2cases of patients after72h, temperature and blood picturewere still high. All patients drew double pigtail stents after8weeks,including5stents disappeared,1case stent displaced.Cysts of all cases reduced in postoperative4weeks CT examination,and postoperative12weeks,including22cases with cyst disappeared,2cases with cyst decreased.Group B3:3cases were positive in fluid culture, of patients after72h urine amylase were still high,2cases of patients after72h, temperature and blood picturewere still high. All patients drew double pigtail stents after8weeks,no stents disappeared,1case stent displaced.Cysts of the cases reduced in postoperative4weeks Eus examination,and postoperative12weeks,including8cases with cyst disappeared,6cases with cyst decreased,1case of cyst patients with preoperative did not decrease.Conclusion:1.Under the existing endoscopic equipment and technical implications,guided by Eus PPC incision endoscopic treatment options was better,and avoided damage to surrounding organs and large blood vessels.the effect was safe and reliable,fewer complications,when drainage was not complete,which did not affect the continued operation results.2.Compared to group A and group B,AP4weeks and after6weeks under the line Eus-guided puncture and drainage of the stomach could draw that the probability of using the AP line Eus-guided drainage of stomach infection and induced pancreatitis was lower after surgery6weeks.3.Compared to group B1and group B2,when puncture drainage of the stomach was guided by Eus,we drainage the nasal cyst pipe,the probability of fever (absorbs heat) of postoperative patients was higher,but there were many good aspects,For example,stent blockage ratio was low,good drainage effect,low infection rate.For patients with PPC whose infection bags fluid and necrotic tissue of were more,nasal cyst drainage tube should be placed normally during operation.4.Compared to group B1and group B3,Eus guided by puncture drainage after8weeks.out of the stomach PPC stent drainage effect was better,no drainage mouth infections and other complications,support time can be extended appropriately,the effect was more secure.