cyst jejunostomy

Cyst jejunostomy is used for the surgical treatment of pancreatic pseudocysts. The cystic disease of the pancreas may be congenital, neoplastic, parasitic, inflammatory, traumatic, etc. According to whether there is epithelial cell layer on the inner wall of the cyst, it is divided into true cyst with epithelial lining and false lining without epithelial cells. The second category of cysts. The true cyst is a neoplastic cyst that requires surgical removal of the cyst and part of the pancreas. Pseudocysts are the most common and can occur after acute pancreatitis, pancreatic injury, pancreatic surgery, and sometimes the real cause is not clear. Pancreatic pseudocysts can occur in the pancreatic parenchyma, in the extra-pancreatic small omental sac or in the retroperitoneal space around the pancreas. The formation of pancreatic pseudocyst is caused by the accumulation of pancreatic juice, exudate, necrotic tissue and blood, which stimulates the surrounding tissue to produce inflammation and the proliferation of fibrous connective tissue, forming a fibrous wall. Therefore, the wall of the pseudocyst has no epithelial cells, which is the identification point of the biopsy to distinguish between true cysts and pseudocysts. Since the wall of the pseudocyst is formed only by the inflammatory reaction of the surrounding tissue, there is no real cyst wall, so it cannot be separated from the surrounding tissue and cannot be removed separately. The pathogenesis of pancreatic pseudocysts can be divided into acute phase and chronic phase, and the acute phase often manifests as effusion in small net sac. In acute pancreatitis, B-mode ultrasound can be used to determine. In the acute phase, the effusion can be absorbed and the cyst disappears; if the cyst communicates with the pancreatic duct, the cyst can not heal itself and often progressively increases, the pressure rises, and the wall of the capsule is thin, it is possible to wear it to the free In the peritoneal cavity, it can also collapse into the intestinal lumen. Pseudocysts become a pancreatic abscess after infection and cause a sharp deterioration of the condition. The acute stage of pseudocyst surgery is mainly external drainage or pouch suture to treat the perforation or infection of the cyst. Chronic pancreatic pseudocyst has a fibrous cyst wall. The fluid in the capsule can be dark green, brown or light yellow. If the cyst communicates with the pancreatic duct, the cyst volume can be gradually increased, and the amylase content of the cyst fluid is high. The cyst fluid can be up to several thousand milliliters. It is generally believed that when the cyst is formed for more than 6 weeks, a more complete fibrous wall can be produced, so the drainage inside the cyst generally takes more than 6 weeks. The relationship between giant pancreatic pseudocysts and intra-abdominal organs. The treatment of chronic pancreatic pseudocyst depends on the volume and location of the cyst. Smaller cysts in the parenchyma of the pancreas can be used to remove the tail of the pancreas together with the cyst and spleen; the cyst in the large omental sac is treated with internal drainage, which can be a cystic stomach anastomosis or a cystic jejunum Roux-en -Y-type anastomosis; pancreatic head cyst can also be used for cyst duodenal anastomosis. Treatment of diseases: pancreatic pseudocyst Indication 1. Large pancreatic pseudocyst, the onset time is more than 6 weeks. 2. No cyst infection or intra-cyst bleeding. 3. Can rule out the possibility of true cysts. Contraindications 1. The cyst is formed for a short period of time without a complete fibrous wall. 2. True cysts. Sometimes the pancreatic or surrounding cystic tumor can be misdiagnosed as a pseudocyst, such as pancreatic cystadenoma or carcinoma, teratoma, duodenal leiomyosarcoma cystic change has been misdiagnosed as a pseudocyst erroneously administered cyst Drainage. 3. Smaller cysts or cysts located in the parenchyma of the pancreas generally do not require in-line drainage unless there is compression, such as pancreatic head cyst compression of the lower end of the common bile duct causing obstructive jaundice. Preoperative preparation 1. Preoperative imaging includes gastrointestinal barium meal examination to determine the location of the cyst and its relationship with the digestive tract. 2. Determination of pancreatic amylase, lipase, and blood glucose. 3. Prepare for general digestive tract surgery. 4. Use prophylactic antibiotics. Surgical procedure 1. Generally, the transverse incision of the upper abdomen is used. It is convenient to explore the pancreas and perform surgery on the left or right side. If the cyst is high in position and protrudes to the small curvature of the stomach, and the surgery is ready for cystic and gastric anastomosis, the left can be used. A straight incision of the upper abdomen on the side. 2. Intraperitoneal exploration to determine the most prominent position of the cyst, choose the lowest position for anastomosis. Generally, the avascular region of the gastric colon ligament or cyst above the transverse colon protrudes from the transverse mesenteric membrane. Be careful not to attempt to separate the cyst wall from adjacent organs, as this will cause the transverse colon to break through because the cyst itself has no real wall. 3. The low incision cyst was about 5cm long. A cyst wall was taken on the margin to send a frozen section for pathological examination. The cystic fluid was taken for bacterial culture and amylase determination. Suck the sac fluid, pay attention to check whether there is a tumor-like protrusion in the sac cavity, and if there is any suspiciousness, take the tissue for pathological examination. 4. Free a section of Roux-en-Y jejunum, about 40 ~ 50cm long, sutured closed at the end of the incision, incision on the mesenteric margin of the intestinal fistula, and the double-walled side of the cyst. An intra-abdominal drainage is placed around the anastomosis, and a puncture is made to lead the abdominal wall.

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