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Objective: To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC)., Material and Methods: There were 5 patients with MPC., Results: Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide., Conclusion: MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.

Chronic pancreatitis complicated by pancreatic duct stones and pancreatic hypertension, post-necrotic cysts and fistulas requires surgical treatment. There are various procedures from minimally invasive to advanced pancreatectomy. Endoscopic interventions and radical open surgery allow to achieve good results. Successful complex treatment of patient with chronic pancreatitis is presented in this report.

An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4–5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant». Postoperative period have passed without complications in all the patients. The drainage was removed on 30–40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

Introduction: In recent years, the practice of abdominal surgery marked increase in the number of patients with pancreatic cysts. Tactics of treatment of this disease is still disputable., Material and Methods: The article analyzes the treatment of 128 patients with formed pancreatic cysts. They were divided into three groups: 1) external drainage - 44 (34.4%); 2) internal drainage - 41 (32.0%); 3) resection surgery - 43 (33.6%)., Results: The duodenum resections were introduced for the treatment of the pancreatic head cysts - 21 (48.8%). Resection methods in the number of postoperative complications (23.3%) could be compared with the operations of the internal drainage of pancreatic cysts (19.5%), although the resection methods are technically more difficult and traumatic. 66 (51.6%) patients were observed in the long-term period. The number of postoperated disease recurrences was more in group 1 (28.6%). Quality of life indicators (SF-36) were higher in group 3. We marked the best results after resection operations., Conclusion: So this type of operation can be recommended for the treatment of patients with formed pancreatic cysts as the most radical method.

In 2009 - 2013 yrs roentgensurgical interventions (RSI) were performed for pancreatic cysts, complicated by intraabdominal hemorrhage, in 26 patients to achieve the hemostasis objective. The hemorrhage recurrence in various terms after endovascular hemostasis have occurred in 6 (23.1%) patients, what have had demanded the intracavity operation performance (in 2) as well as a repeated RSI (in 4). Poor result after application of RSI was noted in 11.5% of observations.

The article presents the results of surgical treatment of 58 patients with pancreatic cysts. An analysis of efficiency of various current miniinvasive surgical methods of treatment is given. Criteria of differential approach to the choice of the kind of miniinvasive intervention in pancreatic and parapancreatic cysts were formulated.

The study is devoted to the surgical treatment of benign pancreatic cysts. Results of the internal drainage of pancreatic duct ul system in 76 patients were analyzed. Pancreaticoenterostomy combined with partial pancreatic resection in 21 cases, was performed in 53 patients. The rest 23 patients required no enterostomy of the main pancreatic duct. The lateral pancreaticojejunostomy was performed in 48 patients, of whom 32 patients had an original reconstructive circulation of the intestinal loop applied. By the width of the pancreatic duct less then 5 mm, the original method of resection of the front surface of the pancreas was applied (n=5). The bilateral pancreaticojejunostomy was performed in 3 patients with the pancreatic duct width less then 5 mm and diastasis of the latter. There was no postoperative lethality; complicated postoperative period required reoperation in 5,3%. Long-term results were considered good in 74,6%, satisfactory in 16,4% and unsatisfactory in 9% of patients.

Treatment of 10 patients with bleedings from the pancreatic cysts was analyzed. Angiography with endovascular occlusion of the source of bleeding was used in 4 patients. Hemostasis was achieved in 2 patients. Emergency operations were made on 7 patients with continuing and repeated bleedings, and unsuccessful attempts of roentgen-endovascular treatment. Two patients after correction of anemia were subjected to planned operations according to the indications accepted for chronic cystic pancreatitis. The operation allows reliable liquidation of the source of bleeding and the symptoms of chonic pancreatitis.

A comparative analysis was made of preoperative computer diagnostics and intraoperative findings in 151 patients operated at various periods of chronic pancreatitis (CP) (n=76) with exacerbation of pancreatitis (or relapsed acute against the background of chronic) and 75 patients without exacerbation. Ninety (59.6%) patients have arrived with complications. Sensitivity of the method of computer tomography in patients with pancreatic exacerbation is 97.4%, without exacerbation is 98.7%. Dilatation of the main pancreatic duct is divided into three degrees. The dilatation of the 2nd and 3d degrees was diagnosed in 78 patients. All the patients were operated on the pancreas in the volume of direct interventions including external drainage which was performed in 69, internal in 56, separately resectional operations in 19, isolated cystectomy in 7 patients, In the group of patients operated out of exacerbation a correlation between the degree of the internal pancreas duct hypertension according to the data of preoperative computed diagnostics and the number of operations of internal drainage was followed. The presence of pancreatitis exacerbation (or relapsed acute against the background of chronic) in 27.5% (n=21) did not allow lateral pancreaticojejunostomy to be performed. In 23 patients the presence of exacerbation, complications of CP due to proper cystic formation (suppuration) and from adjoining organs was not considered contraindication to longitudinal and bilateral pancreaticojejunostomy. Low indices of postoperative lethality (0.7%) and of the number of postoperative complications (6%) confirmed the possibility to liquidate intraductal hypertension in complicated CP at earlier terms that protects the patients from many stages of surgical treatment.

The results of treatment of 264 patients, suffering an acute and chronic pancreatitis, are analyzed. In 30% of observations the liquid peripancreatic accumulations observed have had regressed under the influence of complex conservative therapy and in other--there were performed transcutaneous punctures under ultrasonographic guidance, the cysts drainage, using laparoscopic method. The recurrence free postoperative period had lasted not less than 3 months.

Retrospective analysis of treatment results was carried out in 37 patients that had been treated during 1984-2009 years. Mean age of the patients was 50.7 years; among them 94.6% were women. 8 (21.6%) patients had serous cystadenoma, 21 (56.8%) patients - mucinous cystadenoma, 7 (18,9%) patients - cystadenocarcinoma and 1 (2.7%) patient - intraductal papillary-mucinous tumor. Distal pancreatic resection was carried out to 19 patients, pancreatoduodenal resection - in 5 patients, enucleation - in 10 patients, midline resection - in 1 patient, pancreatectomy - in 2 patients. The frequency of complications amounted 35.1%; lethal outcomes were not observed. Pancreatitis (in 7 patients) and pancreatic fistula (in 4 patients) were the most common complications. Re-laparotomy was necessary for destructive pancreatitis in 2 observations. Other complications were treated conservatively. Long-term results were studied in 28 (76%) patients. Mean duration of the observation was 87,3 months (6-120 months). 5-year survival rate amounted 100% among patients with benign cystic tumors of the pancreas and 25% in patients with cystadenocarcinoma. It is drawn a conclusion that complete recovery is quite possible in patients with benign tumors whereas treatment of the patients with invasive cystadenocarcinoma demonstrate poor results in long-term period.

Data of 14 patients with chronic cystic pancreatitis, complicated by intracystic bleeding, were analyzed. Early diagnosis of a bleeding episode provides an in-time diagnostic and treatment procedures. Angiographic bleeding vessel occlusion is considered to be a method of choice. When the latter is impossible, a method of temporary intraoperative hemostasis is suggested, which decreases blood loss and permits an adequate surgical aid.

Results of treatment of 39 patients with false pancreatic cysts with fine needle aspiration punctures are analyzed. Diagnostic and treatment value of method is discussed; technical aspects of puncture treatment are described. Aspiration puncture method was effective at 59% cases that permitted to reduce the number of external and internal drainage operations at the patients with false pancreatic cysts.

Experience of complex treatment of 137 patients with complicated postnecrotic pancreatic cysts (PPC) is analyzed. Indications to different surgical methods are formulated differentially depending on complications of cysts, localization, sizes, "maturity" of cyst walls, communication with main pancreatic duct. Treatment of festered PPC should be started with minimally-invasive methods; at negative result the omentobursocystostomy with staged endoscopic sanations should be done that permits to decrease the number of postoperative complications and to reduce lethality from 14.3 to 4.5%. Resection of pancreas along with cyst is the operation of choice at pancreatic cysts complicated with bleeding; lethality has been reduced from 28.6 to 5.6%. Perforation of cysts into abdominal cavity is the indication to omentobursocystostomy with staged sanations of omental bursa, perforation into pleural cavity -- to distal resection of pancreas.

Experience in the treatment of cystic lesions of the pancreatic head is analyzed. The method of internal drainage of the pancreatic head cyst with transduodenal approach is described. This methods includes three stages: papillosphincteroplasty, deep virsungotomy with virsungoplasty and cystovirsungoplasty through ducts. The method is named papillovirsungocystoduodenoplasty (PVCDP). Results of 6 successful PVCDP are presented. There were neither recurrence of the cyst nor lethal outcomes.

The authors analyzed results of treatment of 87 patients with cystic formations of the pancreas. According to an experience with treatment the puncture-catheterization of non-formed and complicated cysts is thought by the authors to be the method of choice. For non-complicated well formed cysts the method of choice is operation of internal drainage using different organs. When the puncture-catheterization intervention is not possible the external drainage of the cyst and complex conservative therapy can be the method of choice for complicated cysts. Radical operations (resection of the pancreas) were used for benign cystic tumors. The greatest number of complications were observed after the external drainage of the cyst, cystogastrostomy, resection for cystadenoma and cystadenocarcinoma. Postoperative lethality was 6.8%.

Results of endoscopic drainage of postnecrotic pancreatic cysts in 12 patients were analyzed. Possibilities of the method are limited by location of the cysts in pancreatic head and corpus. Clear visualization of the cysts on the gastric or duodenal wall is the main condition for this procedures feasibility. Surgery must be started with point burning in the wall that is safe and permits the surgeon to stop procedure when cyst is not found. When the cyst is drained through the duodenal lumen, it is necessary to visualize Veter's papilla and perform the procedure below it to prevent lesion of a distal part of the common bile duct. Section of the cyst with wall thickness to 3-4 mm from the duodenal lumen and the ikness to 6-7 mm from the stomach is safe enough. Endoscopic procedures are not indicated in hypertension in the bile ducts.

Results of treatment of 87 patients with cystic pancreatic formation were analyzed. In 38 patients pancreatic cyst had formatted after destructive pancreatitis, in 28--after pancreatic trauma, in 6--due to virsungolithiasis, in 9--cystadenoma was revealed, in 6--cystadenocarcinoma. In 29 patients operation of internal drainage of cyst was performed. Basing on accumulated experience the authors recommend to perform puncture-cathetherizational intervention under ultrasonic investigation and computeric tomography control, when nonformated or complicated pancreatic cyst is present; in the treatment of uncomplicated nonformated pancreatic cyst the operation of internal drainage, using different organs, stomach, duodenum, small intestine, constitutes the method of choice. When it is impossible to perform puncture-cathetherizational intervention, external drainage of cyst and complex conservative therapy may become the method of choice for the treatment of complicated pancreatic cyst. In the presence of benign cystose tumor it is necessary widely apply radical operation--pancreatic resection. The largest frequency of complications occurrence have been noted after external drainage of cyst, performance of cystogastrostomy, pancreatic resection for cystadenoma and cystadenocarcinoma. The principal of them are: the external pancreatic fistula occurrence (in 9.1% of observations), the cyst recurrency (in 5.7%), erosive hemorrhage (in 4.6%), pancreatitis (in 5.4%), suppuration of postoperative wound (in 8%), stenosis of cystodigestive anastomosis (in 2.3%). Postoperative mortality was 6.8%.

A more than 10 year experience of using operative interventions under the control of ultrasound has shown that in order to solve the task of improving the results of surgical treatment of cysts of the pancreatic gland it is necessary to improve a number of diagnostic and organizational measures allowing to perform the early and effective diagnosis of the cysts and their timely treatment. The percutaneous puncture-drainage operations with sclerotherapy are indisputably considered to be highly effective in treatment of cysts of the pancreas. In most patients, however, the clinical and ultrasonic signs of pancreatitis are still retained. These patients need permanent dynamic observation and conservative therapy.

There were examined 130 patients with postnecrotic pancreatic cyst (PNPC). In 16.2% of them the cause of the cyst formation was not established. Operative intervention performance is indicated after establishment of the PNPC diagnosis before occurrence of complications.

Benign pancreatic cystic tumors (BPCT) is a rare and little studied pathological condition. By the end of the eighties approximately 500 registered cases of BPCT were described in the world literature, which were those of different morphological variants of cystadenomas (CA). Many scientists note the high probability of malignant degeneration of some CA types. The diagnostic signs and surgical tactics in BPCT are treated ambiguously. The authors systematized the most characteristic signs of pancreatic CA and revealed the possibility of accurate preoperative recognition of these tumors. From rich clinical material (21 cases) the authors show that complications resulting from an erroneous choice of the operation are inevitable. Postoperative complications occurred in 8 patients. The late-term results of the operation were followed-up in 11 patients and were found to be good and satisfactory in complete removal of the tumor. According to foreign authors, cystic carcinomas of the pancreas account for 1-2% ot all primary carcinomas of the organ. Timely radical operation dictated by the specific features of pancreatic cystadenoma is one of the measures of carcinoma prevention.

The work analyses the results of 999 operations on the pancreas conducted in 861 patients with chronic oncological and nonneoplastic diseases of the gland. Pancreatoduodenal resection (PDR) was performed in 171 patients (for tumors of the pancreaticoduodenal zone in 151 and for chronic pancreatitis of the head of the gland in 20) in 13 of them a modified operation with preservation of the stomach and pylorus was carried out. The late-term results were satisfactory in both groups of patients, the survival of oncological patients was much higher after radical operations then after palliative surgery. Total duodenopancreatectomy has no advantages over PDR and should be undertaken only when there are strict indications. In chronic pancreatitis, complicated also, preference was given to organ-preserving interventions, primarily to draining operations, which preserve more fully pancreatic exocrine and endocrine functions: longitudinal pancreatojejunostomy was conducted in 106 patients, internal drainage of pancreatic cysts in 184, and occlusion of external pancreatic cysts in 70 patients. It is advisable that the most complicated, particularly repeated and reconstructive, operations on the pancreas are carried out at specialized centers in which the problem of surgical diseases of the pancreas is studied more closely.

The results of surgical treatment are analysed on the basis of experience in 131 operations on the pancreas in pancreonecrosis (81 resections of the pancreas, 28 operations for drainage of the cyst in the acute stage, 22 operations for necr- and sequestrectomy). The indications for various types of intervention according to the destruction of the pancreas and the stage of the process are determined. Twenty-one patients died after the operation.

Forty-six patients were treated for cysts and fistulas of the pancreas most of which were caused by destructive pancreatitis and trauma of the pancreas. Operations were performed for pancreatic cysts on 22 patients: marsupialization of the cyst (7 patients), cystoenteroanastomosis (11), resection of the gland together with the cyst (3 patients, one of them died), and cytogastroanastomosis (1). Operations for pancreatic fistulas were carried out in 16 patients. Fistuloenterostomy on a "lost" drain with a jejunal loop excluded after Roux is considered to be the operation of choice in the clinic. The fistula recurred in one patient but was reoperated on successfully.