Diagnostyka i leczenie torbieli rzekomych i guzów torbielowatych trzustki – na podstawie materiału własnego oraz przeglądu literatury

Abstract

Pseudocysts constitute the most basic cystic lesions of the pancreas. Symptomatic cysts may be treated by means of both minimally invasive methods and surgery. Currently, it is believed that approximately 5% of cystic lesions in the pancreas may in fact, be neoplastic cystic tumors. Their presence is manifested by generally irregular multilocular structures, solid nodules inside the cyst or in the pancreatic duct, frequently vascularized, as well as fragmentary thickening of the cystic wall or septation.AimThe aim of this paper was to present current management, both diagnostic and therapeutic, in patients with pancreatic pseudocysts and cystic tumors. The article has been written based on the material collected and prepared in the author's Department as well as on the basis of current reports found in the quoted literature.Material and methods, resultsIn 2000–2012, the Second Department of General, Gastrointestinal and Oncological Surgery of the Alimentary Tract treated 179 patients with cystic lesions in the region of the pancreas. This group comprised 12 cases of cystic tumors and 167 pseudocysts. Twenty-three patients (13.8%) were monitored only and 144 received procedural treatment. Out of the latter group, 75 patients underwent drainage procedures and 48 were qualified to endoscopic cystogastrostomy or cystoduodenostomy. The endoscopic procedure was unsuccessful in 11 cases (23%). In a group of patients with a pancreatic cystic tumor (12 patients), 6 of them (50%) underwent therapeutic resection of the tumor with adequate fragment of the gland.ConclusionsEndoscopic drainage is an effective and safe method of minimally invasive treatment of pancreatic cysts. The patients who do not qualify to endoscopic procedures require surgical treatment. The differentiation of a neoplasm from a typical cyst is of fundamental significance for the selection of the treatment method.

Applications of intraoperative ultrasound in the treatment of complicated cases of acute and chronic pancreatitis and pancreatic cancer – own experience

“…A characteristic feature of serous adenocarcinomas cystoma are numerous small cysts, sometimes with internal calcification forming polycyclic structures. The presence of intraductal papillary mucinous neoplasia (IPMN) of the pancreas (IPMN) is indicated by the image of the cystic enlargement of the pancreatic duct, and the presence of non-uniformly thickened wall – mucinous cystic tumor and internal cystic lesions, and a cystic tumor followed by changes of the non-uniformly thickened wall, with often additional partitions, solid intramural nodules and peripheral calcification ( 7 , 17 , 26 – 28 ) . Depending on the type of tumor, these may include benign or malignant forms, structure infiltration and metastases, including lymph nodes and the liver ( 7 , 26 , 27 ) .…”

“…IOUS is a useful procedure in evaluating the position of pseudocysts in relation to certain parts of the gastrointestinal tract, primarily the stomach and duodenum. This allows for the determination of the correct drainage approach ( 7 , 9 , 28 , 32 ) . Adhesion to the stomach cyst may suggest the use of Jurasz’ method, i.e.…”

“…Cechą charakterystyczną dla gruczolakotorbielaka surowiczego są liczne drobne torbiele, niekiedy z wewnętrznym zwapnieniem, tworzące policykliczne układy. Za obecnością wewnątrzprzewodowego brodawkowo-śluzowego nowotworu trzustki (IPMN) przemawia uwidocznienie torbielowatego poszerzenia przewodu trzustkowego oraz wewnętrznych brodawczakowatych wyrośli, a za śluzotwórczym guzem torbielowatym -obecność zmiany torbielowatej o niejednorodnie pogrubiałej ścianie, często dodatkowe przegrody, lite śródścienne guzki oraz obwodowe zwapnienia (7,17,(26)(27)(28) . W zależności od rodzaju guza mogą to być formy łagodne lub złośliwe, naciekające struktury otaczające oraz dające przerzuty, w tym do węzłów chłonnych i do wątroby (7,26,27) .…”

Intraoperative Ultrasound in the Treatment of Pancreatic Diseases

“…When making a decision about surgical treatment in the peripheral location of the tumour you should take into consideration patient's condition and therefore the existing risks and benefits of the surgery with certain ailments, severity of the local tumour (> 3 cm) and patient's burden. Intraoperative ultrasound in many cases helps to make a final decision as to the scope of the surgery, the resection border and the differentiation of cysts and cystic tumours of the pancreas, although previous studies (not only imaging), but when there are still some diagnostic confusions (4,19,28,30,31).…”

“…Intraoperative ultrasonography determines differences in the construction of cystic, solidcystic and solid lesions in pancreas and in its proximity (2,11,31). In the case of pseudocysts, it allows to locate their exact location in relation to the surrounding organs, which fa-cilitates decision about selecting the proper drainage ( fig.…”