重症急性胰腺炎胰周感染的诊治  

Diagnosis and treatment of peripancreatic infection in severe acute pancreatitis

作　　者：黄竹[1] 汤礼军[1] Huang Zhu;Tang Lijun(PLA Center for General Surgery,Key Laboratory of Pancreatic Injury and Repair of Siehuan Province,General Hospital of Chengdu Military Command,Chengdu 610083,China)

机构地区：[1]成都军区总医院全军普通外科中心胰腺损伤与修复四川省重点实验室,610083

出　　处：《中华胃肠外科杂志》2018年第12期1361-1365,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81772001);四川省应用基础研究重点项目(2018JY0041).

摘　　要：胰周感染是重症急性胰腺炎病情发展过程中常出现的一种严重并发症。尽早诊断、及时有效的预防和治疗直接关系到患者的预后。近年来,随着损伤控制理念的推广应用以及影像介入技术的迅速发展,胰周感染的治疗方案已由早期开腹手术清创转变为“多步骤、升阶梯”式微创外科策略。这一理念及方法的转变使得临床上胰周感染的治疗效果得到了明显改善。尽管如此,目前仍存在许多亟待解决的难题,如抗生素的预防性使用、微创外科技术的选择,以及早期腹腔积液的处理方式等。总之,由于重症急性胰腺炎病程的多变性及复杂性,针对胰周感染的临床治疗及管理目前尚无统一的标准。只有通过外科学、影像学、营养学及重症医学等多学科协同合作,才能真正做到对此类患者进行恰当的风险评估、准确的临床诊断和有效的个体化治疗。The peripancreatic infection is a severe complication during severe acute pancreatitis.Early diagnosis, effective prevention and timely treatment are directly associated to prognosis.In recent years,with the promotion and application of the concept of damage control and the rapid development of imaging intervention techniques,the treatment for peripancreatic infection has become "multi-step,step-up" minimally invasive surgical strategy from early laparotomy.The transformation of this concept and method has significantly improved the efficacy of peripancreatic infection in clinical practice.However,there are still many problems to be solved,such as prophylactic antibiotics,the choice of minimally invasive surgical techniques,and the management of early ascites.In addition,due to the variability and complexity of the course of severe acute pancreatitis,there is no uniform standard for clinical treatment and management of peripancreatic infection.Only through multidisciplinary collaboration,including surgery,imaging,nutrition and intensive care,can we truly achieve appropriate risk assessment,accurate clinical diagnosis and effective individualized treatment for these patients.

关 键 词：胰周感染 升阶梯微创治疗策略 置管引流 胰周坏死组织清创术 

分 类 号：R576[医药卫生—消化系统]