重症急性胰腺炎局部并发症外科干预策略

Surgical intervention strategies for local complications of severe acute pancreatitis

重症急性胰腺炎(SAP)病程后期以感染性胰腺坏死为主的第2次"死亡高峰"是临床治疗的重要挑战。外科医师对感染性胰腺坏死干预指征、时机、策略及方式的掌控尤为重要,对其早期预测与识别、术后管理与协作也需不断加强。目前,感染性胰腺坏死的外科干预呈现微创化、阶段化、多学科化、专业化和多元化特点,临床医师不仅应建立以疾病为中心的综合治疗体系,还应重视SAP的非感染性局部并发症,防患于未然。笔者结合临床实践,就目前SAP局部并发症外科干预的临床实践进行探讨,旨在进一步提高SAP患者后期整体治愈率。

The second"death peak"in the late stage of severe acute pancreatitis(SAP),dominated by infectious pancreatic necrosis(IPN),is a challenge in clinical management.Surgeons play an important role in choosing the indication,timing,strategy and mode of the surgical intervention.Simultaneously,the early prediction and recognition,post-operative management and cooperation of IPN need to be strengthened.Nowadays,some new characteristics including minimal invasiveness,staging,multi-disciplinization,profe-ssionalization and diversi-fication emerge in the modern surgical intervention of IPN.Clinicians should establish a comprehensive treatment system centered on diseases.In addition,clinicians should also pay attention to non-infectious local complications of SAP to prevent the diseases.Based on clinical practice,the authors investigate the clinical practice of surgical intervention for local complications of SAP in order to further improve the overall cure rate of SAP patients in the later period.