Beger H G
Department of General Surgery, University of Ulm, Germany.
Hepatogastroenterology. 1991 Apr;38(2):129-33.
In patients with severe acute pancreatitis, the most important diagnostic goal is differentiation between the interstitial-edematous and the necrotizing type of acute pancreatitis. Surgical management in patients with proven necrotizing pancreatitis is indicated in patients who develop surgical acute abdomen, sepsis, shock syndrome, multisystemic organ failure syndrome, persistent or progressive despite maximum intensive care. The most appropriate procedure for surgical management of pancreatic necrosis is the careful removal of necrosis and preservation of vital pancreatic tissue. Necrosectomy supplemented by postoperative closed continuous lavage of the lesser sac is a procedure that offers the advantages of debridement of devitalized tissue only, and the non-surgical removal of necrotic tissue and bacterially and biologically active compounds. In comparison with a reoperation protocol, necrosectomy and continuous lavage reduce the reoperation rate as well as the need for tracheostomy. In a prospectively treated series of patients suffering from necrotizing pancreatitis, hospital mortality was 8.4% and the reoperation rate 27%. Any tissue becoming necrotic in the postoperative course of disease is rinsed with lavage fluid, thus obviating the need for repeated surgical reoperation in most patients. Local lavage is achieved by the insertion of two, in some cases five, large double-lumen tubus and the use of 8 liters (median) of lavage fluid per day.
在重症急性胰腺炎患者中，最重要的诊断目标是区分急性胰腺炎的间质水肿型和坏死型。对于已证实为坏死性胰腺炎的患者，若出现外科急腹症、脓毒症、休克综合征、多系统器官衰竭综合征，尽管进行了最大程度的重症监护仍持续或进展，则需进行手术治疗。胰腺坏死手术治疗的最合适方法是小心清除坏死组织并保留重要的胰腺组织。坏死组织清除术辅以术后小网膜囊闭合持续灌洗，该方法的优点是仅清除失活组织，非手术方式清除坏死组织以及细菌和生物活性化合物。与再次手术方案相比，坏死组织清除术和持续灌洗可降低再次手术率以及气管切开的需求。在一系列前瞻性治疗的坏死性胰腺炎患者中，医院死亡率为8.4%，再次手术率为27%。疾病术后过程中任何发生坏死的组织都用灌洗液冲洗，从而在大多数患者中避免了重复外科手术的需要。通过插入两根（某些情况下为五根）大型双腔管并每天使用8升（中位数）灌洗液来实现局部灌洗。
