Chapter 9 - Clinical interventional therapy for pancreatic cysts

Abstract

The pancreatic cystic lesion is divided into congenital pancreatic cyst, retention pancreatic cyst and pseudocyst. Among them, pancreatic pseudocyst (PPC) is the most common, accounting for more than 75% of all pancreatic cystic lesions. The main reason is that the pancreatic duct injury or rupture caused by acute, chronic pancreatitis, or trauma leads to the extravasation of the pancreas secreting fluid. When the fluid caused by acute pancreatitis is for more than 4–6 weeks, it can form obvious fibrous granulation tissue wall around. About two-thirds of the patients had traffic between the pancreatic cyst and the pancreatic duct, and the rest could be blocked by the inflammatory response. Traumatic pancreatic pseudocyst is usually caused by severe duct injury and extravasation of pancreatic juice. However, the process of pancreatic pseudocyst caused by chronic pancreatitis is relatively complex, but all have chronic pancreatitis acute and/or main branches of the pancreatic duct for protein bolt, stones or local fibrosis caused by block two basic processes. All eventually lead to the pathological process of fluid in the pancreas and/or peripancreatic abnormally gathered, and the fibrous tissue into the lumen of the parcel form, which often contain pancreatic juice, pancreatic enzyme, granulation tissue, fibrous tissue, and pancreatic necrotic tissue composition, because of the lack of epithelial layer on capsule wall, mainly by the peritoneum, omentum or inflammatory fibrous tissue, so called a pancreatic pseudocyst. When the pancreatic duct is pressed due to various factors such as tumor compression, or such as congestion, inflammatory strictures, it caused far section of pancreatic duct and cystic follicles expansion and pancreatic juice retention, called the retention of pancreatic cyst, accounts for about 10%–20% of pancreatic cyst. Congenital pancreatic cyst is the most rare, which is caused by congenital malformation of pancreatic exocrine gland. Pancreatic body and tail are multiple, which can be divided into single true cyst, pancreatic polycystic disease, enterogenous cyst, and dermoid cyst.