急性坏死性胰腺炎治疗的历史与现状:百年探索二十年突破

History and present status of treatment of acute necrotizing pacreatitis:a breakthrough in the past two decades

一百多年来,围绕急性坏死性胰腺炎的手术和非手术治疗、早期手术还是后期手术进行了艰苦的探索,每一次治疗理念的变革、技术的进步和疗效的突破,均是在实践中总结和逐步完善的。长期临床实践和基础研究,逐步阐明了急性坏死性胰腺炎"两个死亡高峰"的病理生理过程,不断提高早期多器官功能衰竭的防治水平。深化对急性坏死性胰腺炎局部并发症病理转归多样性的认识,划时代改变了坏死性胰腺炎后期的治疗模式,逐步形成了现代综合治疗体系。即在疾病早期,以预防和控制多器官功能衰竭为主轴;在后期阶段,探索最佳手术时机及手术方法为主轴。实施微创与开放相结合的外科干预模式,努力探索和提高针对胰腺坏死组织延期一次性手术清除的成功率。目前,我国不少大中心的坏死性胰腺炎的治疗水平已处于世界前沿,通过中华医学会外科学分会胰腺外科学组对《急性胰腺炎诊治指南(2014)》的巡讲推广及大量的学术交流,我国基层医院急性坏死性胰腺炎治疗水平也在不断提高。因此有理由相信,我国急性坏死性胰腺炎诊疗水平实现再突破的那一天将不再遥远。

For more than one hundred years,the surgery and non-surgery around acute necrosis pancreatitis,early and late stage-operative surgery have been strive explored,and every change in treatment concept,technological progress and breakthrough in efficacy have been gradually summarized and improved in practice.Clinical practice and basic research gradually clarified the understanding of the pathological physiological process of acute necrosis pancreatitis"two peaks of death",greatly improved the treatment of early organ failure,deepened the understanding of the diversity of pathological of local complications of acute necrosis pancreatitis,and changed the treatment mode of necrosis pancreatitis.A modern comprehensive treatment system has been gradually formed.That is,in the early stage of the disease,to prevent and control multi-organ failure as the main axis;In the later stage,to explore the best surgical intervention time as the main axis,the implementation of micro-invasive and open combination of intervention strategy,and strive to explore and improve the success rate of one-time surgery.At present,China′s treatment level of acute necrosis pancreatitis in many large-capacity centers is in the forefront of the world.Through the Pancreatic Surgery Group of Surgery Society of Chinese Medical Association′s tour of the Guide and a large number of academic exchanges,the level of treatment of necrosis pancreatitis in China′s primary hospitals is also constantly improving.Therefore,we have reasons to believe that the day when China′s acute necrotizing pancreatitis diagnosis and treatment level can break further will not be far away.