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1 ,,,, Urokinase df202265@tzuchi.com.tw 34

2 , X X 19.8cm 11.6cm 27.7cm Amylase 129 IU/L X 13.9cm 5.4cm 12.7cm 5.2cm 2.7cm 10.5cm 12F irrigation deep vein thrombosis 12F 4 35

3 19.8cm 11.6cm 27.7cm Hessel 90% 98% 1/3 5 60% 6, cm 11.6cm 27.7cm 1971 Weichel 1976 Hanke 9 Van Sonnenberghg % Murat Cantasdemir 11 96% Criado 21.4% 12 transpapillary drainage 6 ERCP 5Fr. 7Fr. 36

4 13 ERCP 5 Fr % 15 Djamila Boerm 16 15cm Roux-en-Y cm 11.6cm 27.7cm 16 Johnson 17 10% Roux-en-Y % 0-5% Wu Ge 18 Van Sonnenberghg % Murat Cantasdemir 11 96% 37

5 林世彬等 Taiwan Crit. Care Med.2008;9:34-41 圖一術前電腦斷層掃瞄巨大胰臟假圖二術後胰臟囊腫膿瘍的產生小箭性囊腫箭頭指示佔據腹部頭食物殘骸及膿瘍大箭頭一半空間壓迫左腎和其他臟器囊腫內空氣及液體影像圖三用大口徑的導管來經皮導管引流膿瘍箭頭圖四置入二條導管引流膿瘍的腹部Ｘ光小箭頭胸管大箭頭引流管 38

7 01. William R. Brugge. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterology. 2004;20: Anderson MC, Adams DB. Pancreatic pseudocysts: When to drain, when to wait. Postgrad Med.1991;89: , Torres WE, Evert MB, Baumgartner BR, Bernardino ME. Percutaneous aspiration and drainage of pancreatic pseudocysts. AJR Am J Roentgenol.1986;147: Mullins RJ, Malangoni MA, Bergamini TM, Casey JM, Richardson JD. Controversies in the management of pancreatic pseudocysts. Am J Surgery.1998;155: Andrew LW, Carlos FC, David WR. Pancreatic cysts, pseudocysts, and fistulas. In: Michael JZ, Seymour IS, Harold E, eds. Mainogt's abdominal operations, 10th ed. London, Appleton & Lange. 2000: Nealon WH, Townsend CM Jr, Thompson JC. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with pancreatic pseudocyst associated with resolving acute and chronic pancreatitis. Ann Surg.1989;209: Sugawa C, Walt AJ. Endoscopic retrograde pancreatography in the surgery of pancreatic pseudocysts. Surgery.1979;86: Forsmark LE, Grendell JH. Complications of pancreatitis. Semin Gastrointest Dis.1991;2: Hancke S, Pedersen JF. Percutaneous puncture of pancreatic cysts guided by ultrasound. Surg Gynecol Obstet.1976;142: Van Sonnenberg E, Wittich GR, Casola G, Brannigan TC, Karnel F, Stabile BE, Varney RR, Christensen RR. Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases. Radiology.1998;170: Murat Cantasdemir, Batuhan Kara, Fatih Kantarci, Ismail Mihmanli, Furuzan Numan, Sabri Erguney. Percutaneous drainage for treatment of infected pancreatic pseudocysts. The Southern Medical Association. 2003;96: Criado E, De Stefan AA, Wiener TM, Jaques PF. Longterm results of percutaneous catheter drainage of pancreatic pseudocysts. Surg Gyn Obst.1992;175: Neuhaus H. Therapeutic pancreatic endoscopy. Endoscopy.2000;32: Beckingham I, Krige J, Bornman P, Terblanche J. Endoscopic management of pancreatic pseudocysts. British J. Surgery. 1997;84: Martin EW, Catalano P, Cooperman M, Hecht C, Carey LC.Surgical decision-making in the treatment of pancreatic pseudocysts. Internal versus external drainage. Am J Surg.1979;138: Boerma D, Van Gulik TM, Obertop H, Gouma DJ. Internal drainage of infected pancreatic pseudocysts: Safe or sorry? Dig Surg.1999;16: Johnson LB, Rattner DW, Warshaw AL. The effect of size of giant pancreatic pseudocysts on the outcome of internal drainage procedures. Surg Gyn Obst.1991; 170: Wu Ge, Xu Guo-Hui, Li Zheng-Wen, Wu Hai-Xiang, Hu Da-Wu, Wen Hua-Chang, Dual Tian-Hong, Wen Yong-Jun, Wu Hui, Chen Ying- Zhong.Percutaneous catheterizing drainage combined with somatostatin to treat pancreatic pseudocyst. J Intervent Radiol. 2006; 15:

8 MANAGEMENT OF SEVERE COMPLICATION AFTER INTERNAL DRAINAGE SURGERY OF GIANT PANCREATIC PSEUDOCYST: A CASE REPORT AND LITERATURE REVIEW Shih-Pin Lin, Chun-Hung Lin, Huei-Fen Syu, Hsiu-Chen Lin, Wen-Yao Yin Abstract Pseudocyst of pancreas usually follows the acute pancreatitis, chronic pancreatitis, and pancreatic injury. They may be complicated with infection, intestinal obstruction, bleeding and rupture. Among them, bleeding and infection are the most dangerous sequalae of the pancreatic pseudocyst. The treatment of such cyst includes medical treatment such as expectant therapy, percutaneous aspiration, percutaneous drainage, and endoscopic transgastric drainage. Surgical procedures include external drainage, cystogastrostomy, cystoduodenostomy, cystojejunostomy, and pancreatic resection. We here report a 42 years old alcoholic patient sustained acute pancreatitis in 2001 and was treated at other hospital. Two years later, he got abdominal distension, less appetite, and loss of body weight for about 6-7 kg in a few weeks. Abdominal sonographic examination and computed tomography, revealed a giant pseudocyst of pancreas. According to the physical examination and image study, cystojejunostomy is considered to be the best method for this patient. After operation, the complications was seen one after another including immediate postoperative complications such as high blood pressure, tachycardia, tachypnea due to abrupt hemodynamic change probably due to sudden release of the intraabdominal pressure, pancreatic abscess, and deep vein thrombosis. We used percuaneous drainage for pancreatic abscess and multiple wide bore tubes were used for effective drainage. The condition, however, improved with effective external drainage and no recurrence was noted after four years follow up. Key words: Giant pancreatic psuedocyst, Acute pancreatitis, Cystojejunostomy, Pancreatic abscess Correspondence: Dr. Wen-Yao Yin Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital; No. 2. Min-Sheng Road, Salin Town, Chia-Yi, 62247, Taiwan Phone: ext. 5896; Fax: ; df202265@tzuchi.com.tw 41

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09409RAG30-5´ÁH 中華放射醫誌 Chin J Radiol 005; 0: 1-17 1 遺留膽囊管造成總肝管阻塞 :Mirizzi 症候群 1 龐海麟余之泳謝渙發胡順志腐文豪陳震宇劉啟田 1 怡仁醫院放射診斷科三軍總醫院放射診斷脡一轂外科腸胃科膽囊切除手術後剩餘膽囊管