急性胆源性胰腺炎继发感染性胰腺坏死处理方式及时机

Treatment and timing of infected pancreatic necrosis secondary to acute biliary pancreatitis

胆源性胰腺炎作为一种最常见且病因明确的急性胰腺炎,解除病因是其治疗的首要原则。但是对于合并感染性坏死、器官功能衰竭等较重的病情,如何解决胆道问题以及进行坏死组织清创成为一个较为复杂的问题。在病程早晚、感染坏死病灶复杂程度、胆道并发症及器官功能衰竭严重程度等多个因素得到综合评估的基础上制定符合个体化原则的治疗方案应是合理手段。多种微创清创技术及分步强化的清创策略("step-up"策略)的应用虽然已逐渐被广泛认可,但仍有可能因为刻板分步、过度强调微创而造成治疗周期延长、并发症增加等不良后果。针对胆源性胰腺炎,一方面宜积极处理胆道问题为安全清创创造条件,另一方面宜根据局部病灶的复杂程度及器官功能状态妥善处理清创与彻底解决胆道并发症的关系,因此,必须制定一套完善合理的处置流程。

Biliary pancreatitis is one of the most common acute pancreatitis with definite etiology.The first principle of treatment is to remove the etiology.However,for the patients with infectious necrosis and organ failure,how to solve the problem of biliary tract and debridement of necrotic tissue has become a more complex problem.On the basis of comprehensive evaluation of multiple factors,such as the course of disease,the complexity of infection and necrosis,biliary complications and the severity of organ failure,it should be a reasonable means to formulate a treatment plan in accordance with the principle of individualization.Although a variety of minimally invasive debridement techniques and"step-up"strategies have been widely accepted,which may lead to prolonged treatment cycle and increased complications due to rigid step-by-step and over emphasis on minimally invasive surgery.Therefore,in view of biliary pancreatitis,on the one hand,actively deal with biliary problems to create conditions for safe debridement,on the other hand,according to the complexity of local lesions and organ function status,to deal with the relationship between debridement and biliary complications,to develop a set of reasonable treatment process will become necessary.