| 摘要 |
Acute pancreatitis is a common disease ranging in severity from a mild form to
multiple organ failure and sepsis. Approximately half of death due to severe acute
pancreatitis occur within 14 days and most are due to multiple organ failure. The
late deaths are mostly due to infected necrosis. Treatment of severe acute
pancreatitis has shifted from early surgical intervention to aggressive intensive care
in recent years. The principle of therapy is mostly conservative in the early phase,
and surgery is usually considered in the later phase of disease. Surgical debridement
is indicated for removal of infected pancreatic and peri-pancreatic necrosis. With
advances in radiological imaging, interventional radiology, and other minimal
surgical access procedures, the management of many surgical conditions has
changed. Several interventional techniques, including endoscopic retrograde
cholangiopancreatography and endoscopic papillotomy , fine needle aspiration for
bacteriology, percutaneous or endoscopic drainage of peri-pancreatic fluid
collections, pseudocysts, and abscesses, as well as selective transarterial catheter
embolization for associated active bleeding have been well established as diagnostic
and therapeutic standards in the management of acute pancreatitis. With technical
improvements in interventional therapy and minimally invasive surgery, even
infected pancreatic necrosis has successfully been treated in selected patients. The
minimally invasive endoscopic surgery and interventional therapy for infected
necrosis should be limited to specific indications in patients who are critically ill and
unsuitable for surgical laparotomy. The conclusion is that severe acute pancreatitis
remains a serious medical problem, and the effective control of early multiple organ
failure and treatment of systemic complications associated with infected necrosis
require innovative strategies. |
