Nigro Casimiro, Brisinda Giuseppe, Matera Daniele, Maria Giorgio, Brandara Francesco, Sganga Gabriele, Civello Ignazio Massimo
Dipartimento di Scienze Chirurgiche, Istituto di Clinica Chirurgica Unità Operativa di Chirurgia Generale III, Policlinico Universitario Agostino Gemelli, Roma, Italia.
Chir Ital. 2002 Jul-Aug;54(4):455-68.
Acute pancreatitis is a disease capable of the widest clinical expression, ranging from mild discomfort to multiorgan failure and death. Moreover, the process may remain localized in the pancreas, or spread to regional tissues, or even involve remote organs. Despite several efforts, the pathophysiology of acute pancreatitis and its complications remains obscure. In the absence of an understanding of the pathogenesis and the reasons for the variations in severity, the study and management of acute pancreatitis has necessarily been empirical. There is little doubt that the development of pancreatic necrosis in patients with acute pancreatitis results in an increase in clinical severity and an escalation of the mortality risk when compared to interstitial pancreatitis. Furthermore, the mortality risk of patients with sterile pancreatic necrosis is markedly different from that of patients developing secondary infections in pre-existing pancreatic necrosis. Infected pancreatic necrosis is uniformly fatal, if untreated. While most authorities agree that surgical debridement is required for survival in patients with secondary pancreatic infections, the precise form of the subsequent drainage has become a matter of some controversy. In this paper we discuss the most recent insights relating to the nosographical classification of pancreatic necrosis and secondary pancreatic infections, along with an analysis of the findings in the literature regarding the surgical treatment of these conditions.
急性胰腺炎是一种临床表现差异极大的疾病，从轻微不适到多器官功能衰竭乃至死亡。此外，该病程可能局限于胰腺，或扩散至局部组织，甚至累及远处器官。尽管人们做出了诸多努力，但急性胰腺炎及其并发症的病理生理学仍不清楚。由于对其发病机制以及严重程度差异的原因缺乏了解，急性胰腺炎的研究和治疗必然一直是经验性的。毫无疑问，与间质性胰腺炎相比，急性胰腺炎患者发生胰腺坏死会导致临床严重程度增加和死亡风险上升。此外，无菌性胰腺坏死患者的死亡风险与已存在胰腺坏死并发生继发感染的患者明显不同。如果不进行治疗，感染性胰腺坏死无一例外是致命的。虽然大多数权威人士都认为，继发胰腺感染的患者需要进行外科清创才能存活，但后续引流的确切方式已成为一个有争议的问题。在本文中，我们讨论了有关胰腺坏死和继发胰腺感染的疾病分类的最新见解，并分析了文献中关于这些病症外科治疗的研究结果。
