Minimally invasive treatment of postnecrotic pancreatic cysts under ultrasound guidance

Dumansky Y.V., Zubov A.D., Andrienko I.I., Ihsan A. Al-Ameri
Donetsk national medical university. Donetsk, Ukraine

The postnecrotic cysts of the pancreas are often meeting pathology. The optimization of treatment of this heavy illness is the smportant. In it can be perspective the methods of intervention ultrasound.

Methods: Percutaneous puncture draining of 156 postnecrotic cysts of the pancreas were performed. The intervention was performed under continuous ultrasound guidance via a safe acoustic window; during the installation of drainage, assessment of his standing, adequacy of draining and the absence of leakage into the peritoneal cavity the energetic Doppler mode was used. In 5 cases, in the absence of safe acoustic window draining was performed through the stomach. The optimum implementation of the intervention was considered on 3-4 clinical stage of maturation of the cyst, with the need to implement interventions at earlier stages were used a drainage-systems with larger diameter. The adequacy of the drainage standing was assessed by CT fistulography.Microbiological research of cysts content were performed.

Results: Considered mandatory drug therapy to prevent recurrence and complications after the intervention, including adequate analgesia, correction of pancreatic insufficiency, proton pump inhibitors, and early nutrition. Duration of drainage standing ranged from 4 to 25 days. In all cases the clinical effect was achieved in the form of improved physical condition of the patient, reducing the size of the cystic cavity until its complete reduction. The complications observed: pain, which required relief, in 5 patients, peritonitis in 1 case.

Conclusion: In such a way percutaneous drainage is the method of choice in the treatment of postnecrotic pancreatic cysts. The optimum is a continuous ultrasound guidance using the Doppler mode; CT has advantages in the assessment of drainage standing. This approach avoids the open and endoscopic surgery and improve outcomes in patients with pancreatic cysts.