Update: December 2018
Any volumetric processes that are located in the internal
organs, lead to a persistent violation of their functions. Cyst
pancreas is no exception. She represents
is a cavity, the walls of which are formed by connective tissue.
As it forms, the organ tissue is destroyed, which leads
to reduce the secretion of enzymes and hormones necessary for
normal body activity. To restore quality
life of the patient, it is necessary to timely detect this pathology and
choose the right treatment tactics.
In the national clinical guidelines for surgery,
two classifications of pancreatic cysts. Determining criterion
the first is the structure of this formation:
- True cyst – in the presence of epithelial lining, cyst
called true. It is a congenital malformation, which
- False cyst – education that develops after suffering
diseases and not having on its walls glandular epithelium,
denoted as false.
The second classification determines the possible positions of cysts in
- on the head (in the cavity of the stuffing bag) – about the data of the professor
Gd Vilavina, such localization occurs in 16.8% of cases. Her
feature is the possibility of compression of the duodenum;
- on the body – the proportion of these cysts is 47%. It is the most
a frequent arrangement at which displacement occurs
colon and stomach;
- on the tail – is located in 38.2% of cases. Feature
position (retroperitoneal) is extremely rare damage
Since the frequency of occurrence of true cysts is extremely
insignificant, and the clinical picture and treatment principles are largely
coincide, further false forms will be considered.
Causes and predisposing factors
Pancreatic cysts can develop in patients with any
age, be of varying size and quantity. Some
patients, especially with congenital cyst, can
there is a systemic polycystic (polycystic ovary, kidney cysts,
False cyst never occurs in a healthy organ – this one
The process is a consequence of a disease. According to
Professor Kurygin AA, the most common cause
- acute pancreatitis – 84.3% of all cases (see symptoms of acute
- pancreatic injuries – 14% in the structure of the disease, it is
second place in terms of frequency
- short closure of the excretory duct (stone,
clamping vessel) or pronounced violation of its motility
-также может провоцировать образование кисты
- helminthiasis – with cysticercosis, echinococcosis
- the result of a tumor process in the pancreas.
Currently, the Russian Surgical Society highlights
five major predisposing factors. During the clinical
research has proven their importance and the percentage determined risk
Pancreatic cyst development:
- alcohol abuse high fortress –
- gallstone disease – 14%;
- obesity is a violation of lipid metabolism (laboratory manifestation
increased beta-fractions of lipids and cholesterol) – 32.1%;
- past operations on any element of the digestive system
- diabetes mellitus (mainly of the second type) – 15.3%.
The presence of one of the above conditions in a patient with
the onset of symptoms of pancreatic injury allows
suspect the formation of cysts.
Pancreatic Cyst Symptoms
The onset of cyst formation is quite characteristic. Practically
90% of patients it has the following course:
- Severe attack of acute pancreatitis:
- pronounced pains of the shingles nature (less often in epigastria),
which are enhanced after eating or drinking alcohol.
As a rule, the effect of taking NSAIDs (ibuprofen, Ketorolac,
Nimesulide) and antispasmodics (Drotaverin, No-Spa) is absent;
- vomiting without relief;
- symptoms of intestinal dyspepsia (diarrhea, flatulence, bloating
- characteristic “fatty stools”, due to a violation of the secretion of the enzyme
- pronounced pains of the shingles nature (less often in epigastria),
- The disappearance of the symptoms of the disease for 4-5 weeks (“light
the gap “);
- The reappearance of symptoms of lesions of the pancreas.
Often, they are more pronounced and persistent.
Also, the patient may experience:
- low-grade fever
- general weakness
- severe heaviness in the upper abdomen (usually in the left
- in 6% of cases jaundice develops, which is manifested by staining
sclera, mucous membranes of the mouth and skin.
Pancreatic cyst symptoms also include
hormone deficiency: Insulin, Somatostatin,
Glucagon. The patient will complain about:
- frequent frequent urination (up to 15 liters per day)
- dry mouth
- loss of consciousness (with the development of hypo- / hyperglycemic
On examination, in the area of the epigastrium (part of the body under the sternum)
determined by the protrusion of the anterior abdominal wall. This sign
inconstant as it is characteristic only for gland head cysts,
not less than 200 ml. It is noted in 56% of patients, according to statistics.
The gold standard for detecting cysts, including pancreatic
gland is an ultrasound (see preparation for an abdominal ultrasound). AT
Normally, the pancreas is defined as an echogenic formation.
(black on the monitor) with a bumpy surface. In the presence of
such a voluminous process, a rounded object will be visualized
on the background of the gland, with reduced echogenicity (lighter). Often,
bounded by an even contour that is a wall
cysts. The surface of the gland in this place will be smoothed.
If it is difficult to diagnose, you can make a CT or MRTgram.
body. Normal X-ray is not informative. Laboratory methods also
have no diagnostic value, the only thing that can
to alert the doctor in the biochemical analysis of blood is a long
increased amylase levels.
Complications for large cysts
Long-existing large cyst except compression
nearby organs may be accompanied by other complications:
- fistula formation
- abscess or abscess formation
- bleeding due to vascular damage.
Treatment of pancreatic cysts by therapeutic methods
- the pathological focus is clearly limited;
- It has a small volume and dimensions (up to 2 cm in diameter);
- only one education;
- no symptoms of obstructive jaundice and no pain
ATо всех остальных случаях прибегают к хирургическим методам
For the first 2-3 days, a starvation diet is prescribed. AT последующем
It is necessary to limit the intake of fatty, fried and salty foods, since
it stimulates the secretion of pancreatic enzymes and enhances
tissue destruction (see what you can eat for chronic pancreatitis).
Alcohol and smoking should also be excluded. Patient mode –
bed rest (7-10 days).
Tetracycline antibacterial drugs are prescribed.
or cephalosporins, which are aimed at preventing hit
bacterial infection in the cyst cavity and filling it with pus. AT
otherwise, melting of the walls and rapid
the spread of the process in the gland and adjacent tissues.
It is possible to reduce pain and reduce secretion by prescribing
�”Proton pump inhibitors” (OMEZ, Omeprazole, Rabeprazole, and so
Further). For normal digestion of carbohydrates and various
compounds of fats is shown enzyme therapy – drugs, consisting of
which is Lipase and Amylase, but there are no bile acids
If conservative treatment is ineffective for 4 weeks,
surgical intervention is shown.
Modern surgical treatment methods
More than 92% of all patients with pancreatic cyst are treated in
surgical hospital. AT настоящее время, существует около 7-ми
variants of operations that allow you to get rid of this pathology.
Recommendations of the Russian surgical society give
preference for minimally invasive interventions (when the skin is
the patient is practically not damaged).
The least number of complications have percutaneous operations with
a brush that is necessarily carried out simultaneously with ultrasound. They
most effective in localizing the volumetric process in the head
or in the body. The principle of surgical manipulation is quite simple –
after anesthesia, an instrument is inserted into the patient (aspirator or
puncture needle) through a puncture in the epigastric region. AT
Depending on the size of the education, the surgeon can perform:
- Percutaneous puncture drainage of the cyst – after the entire fence
fluids from the cavity establish drainage (thin rubber tube)
to create a permanent outflow. It is not removed until completely
exudate secretion stops. This is necessary for closing
defect connective tissue. The operation cannot be performed if
the cyst closes the duct of the gland or has a significant volume (more
- Percutaneous hardening of the cyst – this technique provides
the introduction of a chemically active solution into the cyst cavity, after
emptying. Result – sanation (cleansing) of the cavity, growth
connective tissue and closure of the defect.
If percutaneous manipulations are not possible, “Surgical standards
Aid “recommends performing laparoscopic interventions. They
provide drawing 2 cuts 1-2 cm long through which
endoscopic instruments are inserted into the abdominal cavity. Operations
have a greater number of potential complications despite
minimally invasive. These include:
- Excision and occlusion of the cyst – is used if available
superficially located education. The operation includes:
opening of the cyst cavity, its sanitation with antiseptic solutions and
suturing the defect “tightly”. Alternatively, it is appropriate to use
electrocoagulator to close the cavity, but in this case
it is necessary to create a permanent outflow (drainage) for 3-7 days;
- Laparoscopic resection of a part of the gland is traumatic.
surgery recommended when there is a large defect inside the tissue
glands. For example, in case of a pancreatic head cyst gland diameter
5-7 cm, remove the entire head. Her преимуществом является низкий риск
- Frey’s operation (resection of the head with the creation of a pancreatojejunal
anastomosis) is a modification of the surgical intervention,
discussed above. Her применение оправдано при сильном расширении
протока glands. The technique of operation is supplemented by sewing this duct.
directly into the wall of the small intestine, which allows you to normalize
enzyme release, and minimize the chance
Inability to perform endoscopic or percutaneous operations
forces to resort to laparotomic interventions (with an autopsy
abdominal cavity). They требуют долгого реабилитационного периода,
however, provide an opportunity to make any amount
surgical action. ATыделяют следующие методики с открытым
- Open resection of a part of the gland;
- Excision and external drainage of the cyst;
- Marsupilization of the cyst – this operation was first tested in
70s of the last century and to date has not lost its
relevance. Her technique is quite original – made
opening and sanitation of the cyst, followed by stitching the walls
education to the edges of the incision. After that – sutured in layers
surgical wound. Thus, closing is achieved.
pathological focus. The disadvantage of this method is frequent
formation of fistulous passages on the anterior abdominal wall.
Pancreatic cysts – quite a rare pathology.
Частота ее встречаемости, по данным профессора AT.AT. ATиноградова
is 0.006% in the world. However, severe symptoms that reduce
quality of life of the patient, require timely
диагностики и treatment. AT настоящее время, врачи могут успешно
deal with this disease. For this, the patient needs
Only take advantage of qualified medical care.