重症急性胰腺炎外科治疗理念与策略的历史变迁  

History of surgical intervention in severe acute pancreatitis treatment

作　　者：王春友[1] 勾善淼[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺病研究所,武汉430022

出　　处：《中华外科杂志》2015年第9期646-648,共3页Chinese Journal of Surgery

摘　　要：重症急性胰腺炎（SAP）发病急骤、病情危重、病理生理过程复杂,从而导致治疗决策困难.SAP的治疗理念历经多次变迁,在保守治疗为主和外科治疗为主间徘徊.19世纪末至20世纪初,Werner Koerte等陆续报道外科治疗SAP成功案例,并使外科手术在未来的30年内占据了SAP治疗的主导地位.继而,陆续有保守治疗SAP成功的案例报道.Peter Walzel在1929年提出保守治疗SAP的疗效优于手术治疗,致使内科治疗开始占据主导.20世纪60年代,SAP治疗再次偏向外科,并且以早期手术为主.直至20世纪90年代,一系列前瞻性研究结果显示保守治疗发生无菌性坏死的SAP效果优于手术治疗,且延迟手术可显著改善患者预后,才使SAP治疗理念再次发生改变.在钟摆式演进的过程中,形成了SAP现代治疗策略：SPA前期以器官支持治疗为主,后期探索最佳手术时机,提高一次手术成功率是最基本的原则.尽管如此,目前SAP病死率仍为5％ - 20％,从事胰腺外科的医师仍应以提高SAP的治疗效果为历史使命,进一步努力研究与探索.Severe acute pancreatitis （SAP） is hard to treat for the abrupt onset,critical condition and complicated pathophysiology.Historically,the treatment strategy of SAP hovered between surgical intervention and conservative treatment.At the turn of the 20th century,SAP was reported to be cured by surgical intervention in a series cases,which lead to the dominance of surgical intervention in SAP treatment.Subsequently,SAP was documented to respond to nonoperative therapy.A wave of conservatism emerged,and surgical intervention for SAP was rarely practiced for the next 3 decades.However,surgeons refined the indications and considered new approaches for surgical treatment in 1960s because of the poor outcomes of conservation,and surgical interventions was mainly performed at early stage of SAP.However,a series of prospective studies showed that conservative treatment of patients with sterile pancreatic necrosis is superior to surgical intervention,and that delayed intervention provide improved outcomes in 1990s,which changed the treatment concept of SAP again.The modern treatment concept formed during the progression：organ supportive care dominates in the early stage of the disease,and surgical intervention should be performed at late stage with proper indications.Despite the advances in treatment,the morbidity of SAP is still 5%-20%,which suggests the pancreatic surgeons＇ exploration in the future.

关 键 词：胰腺炎 急性坏死性 外科手术 药物疗法 

分 类 号：R657.51[医药卫生—外科学]