感染性胰腺坏死手术治疗的时机与策略

Timing and strategy of surgical treatment for infected pancreatic necrosis

感染性胰腺坏死(IPN)是造成急性胰腺炎病人器官功能衰竭及死亡的重要原因,手术是治疗IPN的重要手段。随着循证医学的发展,越来越多的高质量研究为胰腺坏死组织清除术提供了证据,也改变了传统IPN治疗模式。在微创外科时代,是否仍应坚持“延迟手术”及如何实现“延迟手术”成为IPN治疗的研究热点。创伤递进式策略并非所有IPN病人的最佳治疗方案,需积极探索其替代方案,外科开放手术、外科微创手术、内镜下胰腺坏死组织清除术的具体适用范围及优缺点在学界仍未达成共识。目前,个体化、多学科化及微创化的IPN治疗仍是发展主流。笔者探讨IPN手术治疗的时机与策略,以期为临床实践提供理论依据。

Infected pancreatic necrosis(IPN)is a serious complication which may cause organ failure and death in patients with acute pancreatitis.Surgical debridement is an important therapeutic approach for IPN.With the development of evidence-based medicine,more and more high-level evidences emerge for surgical debridement of pancreatic necrosis tissue,and the traditional treatment strategy has also changed.In the era of minimally invasive surgery,whether'delayed surgery'should still be executed and how to achieve'delayed surgery'are the research hotspots in the treatment of IPN.Research evidences reveal that the'step-up'strategy is not the best strategy for all IPN patients,and alternatives should be explored.In addition,the indications,advantages and disadvantages of open surgery,surgical minimally invasive surgery and endoscopic surgical debridement of pancreatic necrosis tissue have been widely discussed in recent years,and no consensus has yet been reached.At present,the personalized,multidisciplinary,and minimally invasive treatment of IPN is still the mainstream development direction.The authors investigate the timing and strategy of surgical treatment for IPN in order to provide theoretical basis for clinical practice.