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Therapie von Pankreaspseudozysten

Endoskopie vs. Chirurgie

Therapy of pancreatic pseudocysts

Endoscopy versus surgery

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Zusammenfassung

Pankreaspseudozysten gehören zu der häufigen Komplikation nach akuter und chronischer Pankreatitis sowie nach abdominellen Traumata. Der Ursprung der Pseudozyste bezieht sich auf enzymatische und nekrotisierende Veränderungen des Pankreas und die Auswirkung entzündlicher Prozesse nach einer Pankreasgangläsion. Symptomatische, progrediente Pseudozysten von über 5 cm Größe nach mehr als 6 Wochen sowie komplizierte Zysten erfordern eine therapeutische Intervention. Eine zystische Neoplasie muss vor jeder Intervention ausgeschlossen werden. Die endoskopischen Methoden gehören zu der primären und am weitesten verbreiteten Behandlung bei Pseudozysten und sollten in der Regel bei allen Patienten angestrebt werden. Ist dies nicht durchführbar, stehen chirurgische Techniken mit vergleichbaren Ergebnissen zur Verfügung. Zusammenfassend erfordert die Pseudozystentherapie eine genaue Diagnostik und ein professionelles multidisziplinäres Management von Gastroenterologen und Chirurgen.

Abstract

Pancreatic pseudocysts are frequent complications following acute and chronic pancreatitis as well as abdominal trauma. They originate from enzymatic and/or necrotizing processes within the organ involving the surrounding tissues through inflammatory processes following pancreatic ductal lesion(s). Pseudocysts require definitive treatment if they become symptomatic, progressive, larger than 5 cm after a period of more than 6 weeks and/or have complications. Cystic neoplasms must be excluded before treatment. Endoscopic interventions are commonly accepted first line approaches. Should these fail or not be feasible surgical procedures have been well established and show comparable results. In summary, pancreatic pseudocysts require a reliable diagnostic approach with a multidisciplinary professional management involving gastroenterologists and surgeons.

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  1. Abteilung für Allgemeine Chirurgie, Viszeral-, Thorax- und Gefäßchirurgie, Klinik und Poliklinik für Chirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland

    M. Patrzyk, S. Maier, A. Busemann, A. Glitsch & C.D. Heidecke

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  1. M. Patrzyk
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  2. S. Maier
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  3. A. Busemann
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  4. A. Glitsch
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  5. C.D. Heidecke
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Correspondence to M. Patrzyk.

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Patrzyk, M., Maier, S., Busemann, A. et al. Therapie von Pankreaspseudozysten. Chirurg 84, 117–124 (2013). https://doi.org/10.1007/s00104-012-2376-9

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