Diagnosis and treatment of pseudopancreatic cysts Pseudopancreatic cysts in children are one of the common pancreatic cysts. Its 30% formed after acute pancreatitis or 60% pancreatic trauma, due to pancreatic tissue necrosis, a large amount of exudate and pancreatic fluid spillage, wrapped by the surrounding fibrous tissue and formed a cyst, rather than growing out of the pancreas. Most of them can be recovered by conservative medical treatment. The formation of pancreatic pseudocysts has a developmental process, generally from 2 weeks to l4 months after the occurrence of pancreatitis or pancreatic trauma, with an average of 6 weeks for the formation of cysts. Pseudopancreatic cysts occur about 2/3 in the tail of the pancreatic body, about 1/3 in the head of the pancreas, mostly located in the front surface of the pancreas superficially, close to the surrounding organs, because the wall of the cyst is not covered by epithelial cells, no secretory function, only fibrous pseudomembrane, so called pseudopancreatic cysts. There is no muscle layer, insufficient blood supply, brittle quality and poor toughness, so the cyst wall is prone to rupture. The clinical manifestations of pancreatic pseudocysts are related to the location and size of the cysts, and the compression symptoms of the cysts are the main ones. 1, abdominal pain: 80% to 90% of patients present with epigastric pain, which is continuous or paroxysmal dull pain and involves the left back. It may be caused by compression of the gastrointestinal and retroperitoneal plexus by the pseudocyst. 2, epigastric mass: about 95% of patients can find an epigastric mass with smooth edges, cystic feeling, poor mobility, and different degrees of pressure pain. 3, gastrointestinal symptoms: due to the cyst compression of the gastrointestinal tract and pancreatic exocrine insufficiency, common gastrointestinal symptoms include nausea, vomiting, epigastric distention and fullness, diarrhea or constipation. In addition, l0% of patients can be accompanied by diabetes, cyst compression of the common bile duct can appear obstructive jaundice, secondary infection in the cyst can cause fever and other signs of infection poisoning; cyst rupture can cause diffuse peritonitis, shock. Diagnosis】 For children with a history of acute pancreatitis or pancreatic injury, it is not difficult to diagnose pseudopancreatic cyst when there is an epigastric mass with abdominal pain and corresponding gastrointestinal pressure symptoms. X-ray abdominal plain radiographs may show pancreatic calcification or calcification of the cyst wall, and barium gastrointestinal meal may show different compression and displacement of the gastrointestinal tract. Ultrasound and CT examination can determine the location and size of the pseudocyst, and the adjacent relationship with the surrounding organs. Complications] The most common complications are secondary infection, cyst rupture and bleeding. 1.Secondary infection is a common complication, and patients may develop symptoms of infection poisoning. Cyst rupture is a very serious complication, with an incidence of 5% and a mortality rate of 40%, which can be accompanied by abdominal pain and signs of peritonitis while the cyst shrinks significantly. 3, bleeding about 8% of patients can have more serious complications, mainly intracapsular bleeding and abdominal hemorrhage of pseudocyst, which is due to cyst infection and corrosion of surrounding large blood vessels. Treatment] The treatment of pancreatic pseudocysts can be divided into non-surgical treatment and surgical treatment. Generally, about 40% of pseudocysts can be absorbed naturally and disappear within six weeks, so non-surgical treatment is mostly used for early or small pancreatic pseudocysts, and the changes in the size of the cysts are observed. Surgical treatment is suitable for children with cysts larger than 5 cm in diameter and longer than six weeks, as well as for children with cysts compressing the digestive tract, obstruction caused by blood vessels, portal hypertension and bleeding. If there is secondary infection, external drainage should be performed as soon as possible, and emergency surgery should be performed for cyst rupture. There are three surgical methods for treating pseudopancreatic cysts: 1. Excisional surgery is the most ideal for removing pseudopancreatic cysts, but it is often difficult to achieve due to severe adhesions, only small cysts limited to the tail of the pancreatic body with few adhesions can be removed, and sometimes the tail of the pancreatic body needs to be removed, and attention should be paid to preserving the spleen as much as possible during surgery. 2. External drainage is to drain the cyst contents directly to the outside of the abdomen. External drainage is simple, but it can cause a large amount of water electrolytes, protein and pancreatic fluid loss, as well as skin erosion. Also the incidence of pancreatic fistula is about 28%, and the recurrence rate of cyst is as high as 20% to 40%. Therefore, except for those who are critically ill and have cysts with secondary infection, rupture or thin and brittle cyst walls that are difficult to drain internally, external drainage is generally not recommended. 3.Internal drainage is the most commonly used surgical method at present. Internal drainage of cysts should be performed 6 weeks after the formation of cysts, because the cyst wall is thin, premature surgery often leads to anastomotic rupture. Commonly used internal drainage procedures are: ① cystic gastric anastomosis; ② cystic duodenal anastomosis; ③ cystic jejunostomy Roux-Y anastomosis.