Cholakov O, Uul V, Gloop B, Zlatarski G, Biukhler M
Khirurgiia (Sofiia). 1999;55(6):42-7.
Treatment of necrotic pancreatitis patients is still disputable, posing serious problems and a real challenge to surgeons. The surgeon's approach to the problem ranges from strictly conservative to extremely aggressive. In this paper are discussed the indications, timing and operative technique used in the treatment of necrotic pancreatitis (NP), with special attention focused on the method suggested by the authors--necrotomy and closed continuous lavage of the retroperitoneum. An algorithm of the therapeutic approach to patients presenting acute pancreatitis is likewise presented. All patients with necrotic pancreatitis are routinely referred for treatment in the intensive care unit (ICU), and mandatorily subjected to antibiotherapy. Only one-third of the cases developing infected pancreatic necrosis (IPN) within 3 weeks of admission undergo operation. Lethality among those operated on is reduced to 13 per cent, and among NP patients--4 per cent. The new concept for therapeutic approach to necrotic pancreatitis patients according to which only cases presenting evidence of infected pancreatic necrosis are liable to surgery, whereas those with SPN should be treated conservatively, is strongly supported.
坏死性胰腺炎患者的治疗仍存在争议，给外科医生带来了严重问题和真正挑战。外科医生对该问题的处理方式从严格保守到极为激进不等。本文讨论了坏死性胰腺炎（NP）治疗中所采用的适应症、时机和手术技巧，特别关注作者所建议的方法——坏死组织清除术及腹膜后封闭持续灌洗。同样还介绍了急性胰腺炎患者治疗方法的流程。所有坏死性胰腺炎患者均常规转入重症监护病房（ICU）治疗，并强制接受抗生素治疗。入院3周内发生感染性胰腺坏死（IPN）的病例中，仅三分之一接受手术治疗。接受手术治疗患者的死亡率降至13%，而NP患者的死亡率为4%。坏死性胰腺炎患者治疗的新概念得到了有力支持，即仅感染性胰腺坏死有证据的病例才适合手术，而无菌性胰腺坏死（SPN）患者应采取保守治疗。
