重症急性胰腺炎的急诊内镜治疗

Emergency endoscopy in the treatment of severe acute pancreatitis

急性胰腺炎(acute pancreatitis,AP)是消化系统疾病中的急重症,其中急性胆源性胰腺炎(acute biliary pancreatitis,ABP)占所有AP病因的58.7%[1]。30年前,内镜逆行胰胆管造影术(emergency endoscopic retrograde cholangiopancreatography,ERCP)和乳头肌切开取石技术的出现,成为了ABP治疗的里程碑。2012年修订版亚特兰大分类(revised Atlanta classification,RAC)标准将AP严重程度分为3类:轻症急性胰腺炎(mild acute pancreatitis,MAP)、中度重症急性胰腺炎(moderate severe acute pancreatitis,MSAP)和重症急性胰腺炎(severe acute pancreatitis,SAP)[2]。SAP早期易发生应激性溃疡并发血,少数患者在后期也可因胰腺包裹性坏死或胰腺假性囊肿(pancreatic pseudocyst,PPC)压迫胃十二指肠引起内瘘并出血。

The high mortality in patients with severe acute pancreatitis(SAP) is a major problem for clinicians. At present, the diagnosis and treatment of SAP has entered a new era of multidisciplinary cooperation and minimally invasive therapy. Endoscopy plays an important role in minimally invasive treatment for SAP, for example gallstone pancreatitis combined with acute cholangitis requires emergency endoscopic retrograde cholangiopancreatography(ERCP), and SAP combined digestive tract bleeding requires emergency endoscopic diagnosis and hemostasis.