Uhl Waldemar, Warshaw Andrew, Imrie Clement, Bassi Claudio, McKay Colin J, Lankisch Paul G, Carter Ross, Di Magno Eugene, Banks Peter A, Whitcomb David C, Dervenis Christos, Ulrich Charles D, Satake Kat, Ghaneh Paula, Hartwig Werner, Werner Jens, McEntee Gerry, Neoptolemos John P, Büchler Markus W
Department of General Surgery, University of Heidelberg, Germany.
Pancreatology. 2002;2(6):565-73. doi: 10.1159/000071269.
During 2002 the International Association of Pancreatology developed evidenced-based guidelines on the surgical management of acute pancreatitis. There were 11 guidelines, 10 of which were recommendations grade B and one (the second) grade A. (1) Mild acute pancreatitis is not an indication for pancreatic surgery. (2) The use of prophylactic broad-spectrum antibiotics reduces infection rates in computed tomography-proven necrotizing pancreatitis but may not improve survival. (3) Fine-needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. (4) Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention including surgery and radiological drainage. (5) Patients with sterile pancreatic necrosis (with negative fine-needle aspiration for bacteriology) should be managed conservatively and only undergo intervention in selected cases. (6) Early surgery within 14 days after onset of the disease is not recommended in patients with necrotizing pancreatitis unless there are specific indications. (7) Surgical and other forms of interventional management should favor an organ-preserving approach, which involves debridement or necrosectomy combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. (8) Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis. (9) In mild gallstone-associated acute pancreatitis, cholecystectomy should be performed as soon as the patient has recovered and ideally during the same hospital admission. (10) In severe gallstone-associated acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery. (11) Endoscopic sphincterotomy is an alternative to cholecystectomy in those who are not fit to undergo surgery in order to lower the risk of recurrence of gallstone-associated acute pancreatitis. There is however a theoretical risk of introducing infection into sterile pancreatic necrosis. These guidelines should now form the basis for audit studies in order to determine the quality of patient care delivery.
2002年期间，国际胰腺病学协会制定了关于急性胰腺炎外科治疗的循证指南。共有11条指南，其中10条为B级推荐，1条（第2条）为A级推荐。（1）轻度急性胰腺炎并非胰腺手术的指征。（2）使用预防性广谱抗生素可降低经计算机断层扫描证实的坏死性胰腺炎的感染率，但可能无法提高生存率。（3）对于脓毒症综合征患者，应进行细针穿刺细菌学检查以区分无菌性和感染性胰腺坏死。（4）有脓毒症临床体征和症状的患者，感染性胰腺坏死是进行包括手术和放射引流在内的干预的指征。（5）无菌性胰腺坏死患者（细针穿刺细菌学检查阴性）应采取保守治疗，仅在特定情况下进行干预。（6）坏死性胰腺炎患者发病14天内不建议早期手术，除非有特定指征。（7）手术及其他形式的介入治疗应倾向于保留器官的方法，即清创或坏死组织切除术，并结合术后管理理念，以最大限度地促进术后腹膜后碎片和渗出物的排出。（8）应行胆囊切除术以避免胆石相关性急性胰腺炎复发。（9）在轻度胆石相关性急性胰腺炎中，患者康复后应尽快行胆囊切除术，理想情况下应在同一住院期间进行。（10）在重度胆石相关性急性胰腺炎中，胆囊切除术应推迟至炎症反应充分消退且临床康复后进行。（11）对于不适合手术的患者，内镜括约肌切开术是胆囊切除术的替代方法，以降低胆石相关性急性胰腺炎复发的风险。然而，存在将感染引入无菌性胰腺坏死的理论风险。这些指南现在应成为审核研究的基础，以确定患者护理的质量。
