重症急性胰腺炎外科干预应重视的问题  

Concerns relating the surgical management of severe acute pancreatitis

作　　者：孙备[1] 冀亮[1] 

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,150001

出　　处：《中华消化外科杂志》2017年第10期987-990,共4页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81372613、81670583）

摘　　要：目前重症急性胰腺炎（SAP）的治疗呈现出微创化、阶段化、多学科化、专业化和多元化特点。由于多种原因，SAP的外科干预普遍相对不足。正确掌握SAP外科干预的时机、指征与方式至关重要，是进一步提高SAP整体治愈率的核心与关键。外科治疗SAP遵循创伤递升式分阶段治疗理念，其适应证除SAP后期并发感染外，还应包括非手术治疗效果不佳、并发腹腔间隔室综合征或多器官衰竭（MOF）的早期SAP。在创伤递升式分阶段治疗SAP过程中，影像学检查引导下的经皮穿刺置管引流可相对较早建立；MOF及囊实混合性病灶是外科清创必要性的独立危险因素；各型开放性清创术的应用价值仍不容忽视。胆源性SAP患者可在同次住院期间接受胆囊切除术，其方式首选LC。在干预手段多元化、微创化的大背景下，外科医师应积极树立自身在多学科团队治疗中的主导地位，勇于担当、敢于出手，避免SAP外科干预的相对不足。Nowadays, some new characteristics emerge in the modem management of severe acute pancreatitis （ SAP）, such as minimally invasive, staging, multidisciplinary, specialized and diversified. There is a prevalent insufficiency in the surgical management of SAP due to various reasons. A precise grasp of timing, indication and manner in the surgical management of SAP is of great importance to further improve the curative rate. Surgical intervention of SAP is performed in a staged step-up framework, which should not only be indicated by infectious complications in the late-phase of SAP, but also by a failure of nonsurgical therapy and a progression to abdominal compartment syndrome and/or multiple organ failure （MOF） in the earlyphase of SAP. In a staged step-up framework, imaging-guided percutaneous catheter drainage could be established relatively early, MOF and heterogeneous collection are independent risk factors of the necessity of surgical debridement, and the merits of open debridement should not be under-estimated. A same-admission cholecystectomy could be arranged for patients with gallstone SAP, and laparoscopic cholecystectomy serves as the initial choice. In the context of minimal-invasiveness and diversification, the surgeons should endeavor to establish their predo- minant role in the multidisciplinary team, preventing from insufficient surgical intervention in the management of SAP.

关 键 词：重症急性胰腺炎 微创外科 外科干预 

分 类 号：R657.51[医药卫生—外科学]