重症急性胰腺炎治疗面临的挑战与对策

Difficulties and countermeasures in the management of severe acute pancreatitis

近年来随着微创及内镜技术的发展,重症急性胰腺炎(SAP)的治疗理念在不断更新。创伤递升式治疗是目前SAP的主流治疗模式,显著提高了其救治成功率。在技术与理念日益更新的背景下,SAP治疗仍存在一些挑战与争议,例如液体复苏的原则、腹腔间隔室综合征(ACS)的处理、感染性胰腺坏死(IPN)外科干预的时机与方式、内镜引流与外科清创孰优孰劣,以及开放清创手术的必要性等问题,均需要进一步高质量临床研究验证。多学科综合治疗协作组至关重要,建立规范的胰腺疾病中心可使更多SAP病人获益。

In recent years,with the development of minimally invasive and endoscopic technology,the treatment concept of Severe acute pancreatitis(SAP)is constantly updated.The“step-up approach”has become the mainstream treatment mode of SAP and has significantly improved its cure rate.Although treatment concepts and techniques are increasingly updated,there are still some challenges and controversies in the treatment of SAP,such as the principle of fluid resuscitation,the management of abdominal compartment syndrome(ACS),the timing and mode of surgical intervention for infected pancreatic necrosis(IPN),the advantages and disadvantages of endoscopic and surgical debridement,and the necessity of open debridement.All the above problems need to be validated by further high-quality clinical studies.Multidisciplinary team is crucial,and establishing standardized pancreatic disease centers can benefit more SAP patients.