Endoscopic Ultrasonography-guided Drainage Of Pancreatic Pseudocysts In A Clinical Study

Objective:To evaluate the effectiveness of endoscopic ultrasonography-guided drainage in the treatment of pancreatic pseudocysts and to analyze the factors affecting the treatment and safety of this technique.Methods:1.Patients with clearly diagnosed pancreatic pseudocysts who were hospitalized at the Affiliated Hospital of Inner Mongolia Medical University between October2018 and December 2021 were collected and divided into: endoscopic ultrasonography-guided drainage group and surgical drainage group according to the treatment method,to compare the clinical effects and safety of the two treatment methods for pancreatic pseudocysts.2.Treatment options:(1)Endoscopic ultrasonography-guided drainage group:Patients treated with endoscopic ultrasonography were given preoperative cardiac and oxygen blood pressure monitoring,established intravenous access,intravenous diazepam 10 mg,scopolamine hydrochloride(654-2)10 mg,and pethidine hydrochloride 50 mg,followed by selection of linear array endoscopic ultrasonography to scan the lesion,and according to the size and location of the pancreatic pseudocyst,and the degree of clarity of the cyst fluid(The puncture site and drainage method were selected according to the size,location,and clarity of the cyst fluid(clear,turbid,and whether there was obvious necrotic tissue).Endoscopic ultrasonography-guided plastic stent placement,endoscopic ultrasonography-guided plastic stent placement drainage and nasal cyst drainage tube placement,and endoscopic ultrasonography-guided nasal cyst drainage tube placement were performed,respectively.(2)Surgical drainage group: general anesthesia,patient lying supine,routine disinfection,sterile sheets,taking a median incision in the upper abdomen,incising each layer of the abdominal wall in turn,and choosing external drainage,internal drainage(cystic gastric anastomosis,cystic jejunostomy or duodenal anastomosis)and pseudocystectomy respectively according to the site and size of pancreatic pseudocysts seen during surgery.3.Some patients may need anti-infective treatment and symptomatic treatment.Non-invasive electrocardiogram,arterial oxygen saturation detection and blood pressure monitoring must be given for 12 hours,and if the patient’s condition changes,continuous electrocardiogram,arterial oxygen saturation detection and blood pressure monitoring should be changed,and medical staff and family members should pay close attention to any symptoms such as chills and high fever,abdominal distension and nausea,and any complications such as gastrointestinal bleeding,intestinal obstruction and peritonitis.4.All patients were followed up after discharge,including the patients’ general condition,the regression and recurrence of cysts on imaging,and whether they received other treatments.Results:1.Endoscopic ultrasonography puncture and surgical results: among 19 patients with pancreatic pseudocysts treated by ultrasonic endoscopy,puncture was unsuccessful in 1 patient,but successful in the rest,with a puncture success rate of94.7%(18/19).Among them,6 cases had plastic stent placed by puncture,5 cases had plastic stent and nasal cyst drainage tube placed,and 7 cases had nasal cyst drainage tube placed;29 patients were treated by surgery,and all of them completed the surgery successfully,including 6 cases of external drainage,20 cases of internal drainage,and 3 cases of pseudocystectomy.2.Complications:(1)Endoscopic ultrasonography-guided drainage group: In the group with simple plastic stent placement,one patient developed abdominal distension and pneumothorax was found on CT examination,and the pneumothorax was cured and the cyst subsided after conservative treatment;one case developed stent obstruction,cyst infection,and poor drainage due to blockage of the plastic stent by necrotic material inside the capsule,and fever developed,and after anti-infection treatment and stent replacement,the effect was still poor,and the patient was referred to surgery for internal drainage.No complications occurred in the other two groups.The incidence of complications in the ultrasound endoscopic treatment group was11.1%(2/18).(2)Surgical drainage group: four cases of postoperative gastrointestinal bleeding,one of which was reoperated with small artery suture of the gastric wall and improved after acid-suppression and rehydration and nutritional support treatment;two cases of postoperative pancreatic fistula,one of which formed a sinus tract and was operated with sinus jejunostomy;There was one case of postoperative abdominal infection that improved with anti-infection medication and did not result in death.The surgical therapy group had a 24.1 percent complication rate.3.Follow-up:(1)Endoscopic ultrasonography-guided drainage group: 1 case of pseudocyst recurrence was reviewed 3 months after surgery and underwent surgical treatment,with a recurrence rate of 5.6%(1/18).(2)Surgical drainage group: 1 case of recurrence,considered pancreatic cystic adenoma was not excluded and was treated by surgery again,postoperatively confirmed as pancreatic cyst,with a recurrence rate of 3.4%(1/29).There were no lost cases and no death cases.4.In the endoscopic ultrasonography-guided drainage group,the difference in complication rates between procedures was not statistically significant.(P=0.163>0.05)5.There was no statistically significant difference in the treatment efficiency of pancreatic pseudocysts in the endoscopic ultrasonography-guided drainage group with different general information(e.g.,age,gender,combined diabetes,combined hypertension,combined coronary artery disease).(P>0.05)6.The treatment efficiency of pancreatic pseudocysts with the largest diameter(≤10 cm)in the endoscopic ultrasonography-guided drainage group was higher than the largest diameter(>10 cm)The difference was statistically significant.(P=0.043<0.05)7.The treatment efficiency of the endoscopic ultrasonography-guided drainage group intervention of placing nasal cyst drainage tube was higher than that of placing stent drainage alone The difference was statistically significant.(P=0.037<0.05)8.The differences in treatment efficiency(83.3% vs.89.7%),complication rate(11.1% vs.24.1%),and recurrence rate(5.6% vs.3.4%)between the endoscopic ultrasonography-guided drainage group and the surgical drainage group were not statistically significant.(P>0.05)9.There was no statistically significant difference(P>0.05)between the endoscopic ultrasonography-guided drainage group and the surgical drainage group in terms of hospital days(18.39 ± 6.98 vs.22.20 ± 6.43),but the difference in hospital charges(29267.41 ± 4512.63 vs.47723.55 ± 17590.60)was statistically significant.(P<0.05)Conclusion:1.Endoscopic ultrasonography-guided drainage of pancreatic pseudocysts and surgery are both effective means of treating pancreatic pseudocysts,but endoscopic ultrasonography-guided drainage of pancreatic pseudocysts is less invasive,has a shorter hospital stay,and is less expensive,which is worth promoting in clinical treatment.2.Endoscopic ultrasonography-guided drainage of pancreatic pseudocysts should be selected for smaller maximum diameter(≤10 cm)to obtain better results.3.The placement of plastic stents and nasal cyst drains during endoscopic ultrasonography treatment of pancreatic pseudocysts can improve patient outcomes.