重症急性胰腺炎治疗的争议与共识

Controversy and consensus of the therapy for severe acute pancreatitis

重症急性胰腺炎（severe acute pancreatitis．SAP）病因复杂，发展迅速，是一种特殊类型的急腹症，其治疗的争议从来没有停止过。随着对SAP发病机制研究的深入，其总体治疗方案不断完善，目前形成“以微创为先导，多学科手段交织”的SAP综合治疗模式，使SAP的疗效有很大提高，但对于SAP的规范化治疗仍有较大争议。本文结合国内外文献和笔者单位的临床实践对SAP治疗的争议与共识做一简要阐述。

With the characteristics of complicated etio- logic factors, multiple complications and high mortality, severe acute pancreatitis （SAP） has been treated by all kinds of clini- cal management. Management of SAP is a hot topic in recent decades. Researches on the pathophysiology of SAP have advanced dramatically during the past 20 years. As the number of randomized controlled studies of SAP has steadily increased, mainly in the United States management was demanded for and Europe, evidence based the management of SAP. The main improvement of the treatment results was achieved following internationally accepted recommendations ; however, some as- pects of the management are different and need to be discussed. There has been no consensus regarding the treatment of SAP. Failure to provide definitive treatment may potentially put a patient at risk of a fatal episode of SAP. The aims of this study, therefore, were to survey the currently adopted practice of the management of SAP, to evaluate the impact of various subspe-cialty interests on the practice adopted, and to suggest pathways towards a better implementation of the guidelines and other evidence-based management approaches.