重症急性胰腺炎的微创干预策略

郑琦; 刘建生

doi:10.3969/j.issn.1001-5256.2020.08.051

重症急性胰腺炎的微创干预策略

DOI: 10.3969/j.issn.1001-5256.2020.08.051

郑琦,
刘建生

山西医科大学第一医院肝胆胰外科

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中图分类号: R576
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出版历程
- 出版日期: 2020-08-20

Minimally invasive intervention strategy for severe acute pancreatitis

Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University

摘要

摘要:
重症急性胰腺炎(SAP)是消化系统常见的危重疾病,病情进展快,临床转归多样,病死率较高。随着微创技术的不断发展,SAP的外科干预策略发生了重大的转变。外科干预模式正朝着微创化、多学科化和个体化方向发展。目前,创伤递升分阶段治疗理念和延迟干预理念已经获得了临床医生的普遍认可和接受。准确把握外科干预指征、重视外科干预时机的选择、选择合理的外科干预方式已成为临床上SAP外科干预治疗的关键。注重多学科团队协作与个体化原则,正确认识微创干预的作用与地位,有利于进一步提高SAP患者的整体治愈率。
- 胰腺炎 /
- 最小侵入性外科手术 /
- 治疗学
Abstract:
Severe acute pancreatitis(SAP) is a common critical disease of the digestive system with rapid progression,multiple clinical outcomes,and high mortality rate.With the development of minimally invasive technology,the surgical intervention strategies for SAP have changed greatly,and the mode of surgical intervention is developing towards minimal invasiveness,multidisciplinary cooperation,and individualization.At present,the treatment concepts of“step-up approach”and delayed intervention have been widely accepted by clinicians.Accurately grasping the indications for surgical intervention,emphasizing the timing of surgical intervention,and selecting a reasonable mode of surgical intervention have become the key to successful surgical intervention for SAP in clinical practice.Emphasis on the principles of multidisciplinary cooperation and individualization and a correct understanding of the role and status of surgical intervention may help to further improve the overall cure rate of SAP patients.
- pancreatitis /
- minimally invasive surgical procedures /
- therapeutics

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参考文献(31)

[1] Pancreas Study Group,Chinese Society of Gastro-enterology,Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis(Shenyang,2019)[J]. J Clin Hepatol,2019,35(12):2706-2711.(in Chinese)中华医学会消化病学分会胰腺疾病学组，《中华胰腺病杂志》编委会，《中华消化杂志》编委会．中国急性胰腺炎诊治指南(2019年，沈阳)[J]．临床肝胆病杂志，2019,35(12):2706-2711.

[2] IYER S,BAWA EP,TARIQUE M,et al. Know thy enemy-understanding the role of inflammation in severe acute pancreatitis[J]. Gastroenterology,2020,158(1):46-48.

[3] TRIKUDANATHAN G,WOLBRINK D,van SANTVOORT HC,et al. Current Concepts in severe acute and necrotizing pancreatitis:An evidence-based approach[J]. Gastroenterology,2019,156(7):1994-2007. e3.

[4] CIROCCHI R,TRASTULLI S,DESIDERIO J,et al. Minimally invasive necrosectomy versus conventional surgery in the treatment of infected pancreatic necrosis:A systematic review and a meta-analysis of comparative studies[J]. Surg Laparosc Endosc Percutan Tech,2013,23(1):8-20.

[5] van SANTVOORT HC,BESSELINK MG,BAKKER OJ,et al. A step-up approach or open necrosectomy for necrotizing pancreatitis[J]. N Engl J Med,2010,362(16):1491-1502.

[6] HOLLEMANS RA,BAKKER OJ,BOERMEESTER MA,et al.Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis[J]. Gastroenterology,2019,156(4):1016-1026.

[7] GARG PK,ZYROMSKI NJ,FREEMAN ML. Infected necrotizing pancreatitis:Evolving interventional strategies from minimally invasive surgery to endoscopic therapy-evidence mounts,but one size does not fit all[J]. Gastroenterology,2019,156(4):867-871.

[8] KE L. Minimally invasive surgical management for infected pancreatic necrosis[J]. Chin J Pancreatol,2019,19(6):408-410.(in Chinese)柯路．胰腺坏死组织感染的微创外科治疗[J]．中华胰腺病杂志，2019,19(6):408-410.

[9] DARRIVERE L,LAPIDUS N,COLIGNON N,et al. Minimally invasive drainage in critically ill patients with severe necrotizing pancreatitis is associated with better outcomes:An observational study[J]. Crit Care,2018,22(1):321.

[10] SAMANTA J,RANA A,DHAKA N,et al. Ascites in acute pancreatitis:Not a silent bystander[J]. Pancreatology,2019,19(5):646-652.

[11] ROGERS WK,GARCIA L. Intraabdominal hypertension,abdominal compartment syndrome,and the open abdomen[J].Chest,2018,153(1):238-250.

[12] ARVANITAKIS M,DUMONCEAU JM,ALBERT J,et al. Endoscopic management of acute necrotizing pancreatitis:European Society of Gastrointestinal Endoscopy(ESGE)evidencebased multidisciplinary guidelines[J]. Endoscopy,2018,50(5):524-546.

[13] CROCKETT SD,WANI S,GARDNER TB,et al. American gastroenterological association institute guideline on initial management of acute pancreatitis[J]. Gastroenterology,2018,154(4):1096-1101.

[14] TLLEZ-AVIA FI,CASASOLA-SNCHEZ LE,RAMíREZLUNA M，et al. Permanent indwelling transmural stents for endoscopic treatment of patients with disconnected pancreatic duct syndrome:Long-term results[J]. J Clin Gastroenterol,2018,52(1):85-90.

[15] van DIJK SM,HALLENSLEBEN N,van SANTVOORT HC,et al. Acute pancreatitis:Recent advances through randomised trials[J]. Gut,2017,66(11):2024-2032.

[16] QIN HY,KONG ZH,YANG GY. An excerpt of 2019 WSES guidelines for the management of severe acute pancreatitis[J]. J Clin Hepatol,2019,35(10):2185-2190.(in Chinese)秦会园，孔子昊，杨桂元．《2019年世界急诊外科学会重症急性胰腺炎诊治共识》摘译[J]．临床肝胆病杂志，2019,35(10):2185-2190.

[17] TRIKUDANATHAN G,TAWFIK P,AMATEAU SK,et al. Early(<4 weeks)versus standard(≥4 weeks)endoscopically centered step-up interventions for necrotizing pancreatitis[J]. Am J Gastroenterol,2018,113(10):1550-1558.

[18] van BRUNSCHOT S,HOLLEMANS RA,BAKKER OJ,et al.Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis:A pooled analysis of individual data for 1980 patients[J]. Gut,2018,67(4):697-706.

[19] LI H,WU Y,XU C,et al. Early ultrasound-guided percutaneous catheter drainage in the treatment of severe acute pancreatitis with acute fluid accumulation[J]. Exp Ther Med,2018,16(3):1753-1757.

[20] MEHTA V,KUMAR R,PARKASH S,et al. Role of percutaneous catheter drainage as primary treatment of necrotizing pancreatitis[J]. Turk J Gastroenterol,2019,30(2):184-187.

[21] van GRINSVEN J,van SANTVOORT HC,BOERMEESTER MA,et al. Timing of catheter drainage in infected necrotizing pancreatitis[J]. Nat Rev Gastroenterol Hepatol,2016,13(5):306-312.

[22] SUGIMOTO M,SONNTAG DP,FLINT GS,et al. Better outcomes if percutaneous drainage is used early and proactively in the course of necrotizing pancreatitis[J]. J Vasc Interv Radiol,2016,27(3):418-425.

[23] RASSLAN R,DA COSTA FERREIRA NOVO F,ROCHA MC,et al. Pancreatic necrosis and gas in the retroperitoneum:Treatment with antibiotics alone[J]. Clinics(Sao Paulo),2017,72(2):87-94.

[24] LEPPNIEMI A,TOLONEN M,TARASCONI A,et al. 2019 WSES guidelines for the management of severe acute pancreatitis[J].World J Emerg Surg,2019,14:27.

[25] van BRUNSCHOT S,FOCKENS P,BAKKER OJ,et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis:A systematic review[J]. Surg Endosc,2014,28(5):1425-1438.

[26] BARON TH,DIMAIO CJ,WANG AY,et al. American gastroenterological association clinical practice update:Management of pancreatic necrosis[J]. Gastroenterology,2020,158(1):67-75. e1.

[27] BANG JY,ARNOLETTI JP,HOLT BA,et al. An endoscopic transluminal approach,compared with minimally invasive surgery,reduces complications and costs for patients with necrotizing pancreatitis[J]. Gastroenterology,2019,156(4):1027-1040. e3.

[28] van BRUNSCHOT S,van GRINSVEN J,van SANTVOORT HC,et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis:A multicentre randomised trial[J].Lancet,2018,391(10115):51-58.

[29] ASGE Standards of Practice Committee,MUTHUSAMY VR,CHANDRASEKHARA V,et al. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections[J]. Gastrointest Endosc,2016,83(3):481-488.

[30] LIU X,GUO XZ,LI HY,et al. Effect of enteral nutrition by transnasal gastroscope placement of nasal jejunum nutrition tube in the treatment of severe acute pancreatitis[J]. Trauma and Crit Medicine,2018,6(2):100-102.(in Chinese)刘旭，郭晓钟，李宏宇，等．鼻胃镜介导安置鼻空肠营养管治疗重症急性胰腺炎疗效分析[J]．创伤与急危重病医学，2018,6(2):100-102.

[31] Professional Committee of Pancreatic Disease,Chinese Medical Doctor Association. Chinese consensus on the multidisciplinary treatment(MDT)of acute pancreatitis[J]. J Clin Hepatol,2015,31(11):1770-1775.(in Chinese)中国医师学会胰腺病学专业委员会．中国急性胰腺炎多学科诊治共识意见[J]．临床肝胆病杂志，2015,31(11):1770-1775.

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