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Percutaneous Puncture of Cystic Diseases of the Pancreas under Ultrasonic Guidance Takeo Yamanaka 1 , Norio Ueno 2 , Ken Kimura 2 1Department of Gastroenterology, Jichi Medical School Omiya Medical Center 2Department of Gastroenterology, Jichi Medical School pp.189-196
Published Date 1990/2/25
DOI https://doi.org/10.11477/mf.1403110386
  • Abstract
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 Ultrasonically guided percutaneous puncture was performed on 29 patients with pancreatic cystic lesion and 5 patients with liver cyst. The final diagnoses confirmed by clinical findings, exploratory laparotomy and/or autopsy were pancreatic pseudocyst in 12 cases (postinflammatory 11, post-traumatic 1), pancreatic retention cyst in 5 cases, pancreatic cystadenoma in 2 cases, pancreatic cystadenocarcinoma in 6 cases, pancreatic solid adenocarcinoma with central necrosis in 4 cases and congenital liver cyst in 5 cases.

 The clinical purposes of the procedure are for (1) biochemical, bacteriological and cytological examinations of aspirated fluid from the cyst, (2) roentgenographic visualization of the cyst by direct injection of contrast medium, and (3) complete aspiration of the fluid from the cyst as a therapeutic treatment. We report here the results of our study on biochemical and cytological examinations of cystic fluid, and roentgenographic visualization of the cysts.

 (1) Examinations of aspirated fluid from the cysts. The aspirated fluid proved to be fairly diagnostic. In pseudocysts, the concentration of amylase in the aspirated fluid was very high, compared with that in other cystic lesions. This finding was very useful in distinguishing pseudocyst from true cysts.

 The concentrations of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) were high in the fluid of true cysts (retention cyst, cystadenoma, cystadenocarcinoma), compared with that in the fluid of pseudocyst.

 Results of cytological examinations were as follows, as was expected: Class Ⅰ in all cases of benign cysts (pseudocyst, retention cyst, cystadenoma, congenital liver cyst), Class Ⅲ in 2 of 6 cases with cystadenocarcinoma, and Class Ⅴ in 6 of 8 cases with malignant cysts (cystadenocarcinoma, solid adenocarcinoma). Thus the cytological examination of cystic fluid was useful in distinguishing benign cyst and malignant cyst.

 (2) Roentgenographic visualization of the cysts. This method may be very useful in clearly demonstrating outline and location of the cysts.

 Because of its safety, easiness and diagnostic reliability, the procedure is expected to be applied more widely and frequently in the differential diagnosis of cystic diseases of the pancreas.


Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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