Bakker Olaf J, van Santvoort Hjalmar C, Besselink Marc G H, van der Harst Erwin, Hofker H Sijbrand, Gooszen Hein G
University Medical Center Utrecht, Department of Surgery, HP G04.228, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Curr Gastroenterol Rep. 2009 Apr;11(2):104-10. doi: 10.1007/s11894-009-0017-3.
The management of infected peripancreatic or pancreatic necrosis in patients with severe pancreatitis has changed considerably in recent years. This review discusses the recent literature on prevention, detection, and management of infected necrosis. Though antibiotics, probiotics, and enteral nutrition have been tried to prevent infected necrosis, only enteral nutrition has consistently proven to be effective. Antibiotics and probiotics have not shown a consistent beneficial effect on outcome. Enteral nutrition reduced infectious complications and mortality in severe pancreatitis, compared with parenteral nutrition. The detection of infection of pancreatic necrosis is important for clinical decision making. Fine-needle aspiration may be used to confirm suspected infection, but if its results will not change clinical decisions, it should be omitted, as it may even introduce infection. Minimally invasive surgical, radiologic, or endoscopic intervention is increasingly being applied. In the absence of level 1 evidence, local expertise dictates which type of intervention is applied.
近年来，重症胰腺炎患者感染性胰周或胰腺坏死的管理发生了很大变化。本文综述讨论了关于感染性坏死的预防、检测和管理的最新文献。尽管曾尝试使用抗生素、益生菌和肠内营养来预防感染性坏死，但只有肠内营养一直被证明是有效的。抗生素和益生菌对预后并未显示出一致的有益效果。与肠外营养相比，肠内营养可降低重症胰腺炎的感染性并发症和死亡率。胰腺坏死感染的检测对临床决策很重要。细针穿刺可用于确认疑似感染，但如果其结果不会改变临床决策，则应省略，因为它甚至可能引入感染。微创外科、放射或内镜干预的应用越来越多。在缺乏一级证据的情况下，由当地专业知识决定采用哪种类型的干预措施。
