Szentkereszty Zsolt, Kotán Róbert, Damjanovich László, Sápy Péter
Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar, Sebészeti Intézet, Debrecen.
Orv Hetil. 2010 Oct 10;151(41):1697-701. doi: 10.1556/OH.2010.28956.
In case of mild acute pancreatitis the treatment is basically conservative, but in severe cases surgical treatment has an important role.
authors analyze the indications for operation, the timing and the technical questions of it on the basis of the literature published in the previous ten years.
sterile pancreas necrosis is rarely but septic necrosis is an indication for surgery if the conservative treatment is unsuccessful. Therapy resistant multiple organ failure, abdominal compartment syndrome and other surgical complications such as bleeding, perforation need surgery treatment. In biliary pancreatitis associated with cholestasis urgent endoscopic sphincterotomy and later cholecystectomy is suggested. In case of pancreas necrosis the ideal time of operation is 21 days after the beginning of the disease because the rate of complications and mortality is high in early operations. Careful necrosectomy is important which has to be extended to the retrocolic and retroduodenal areas as well. Open abdominal surgery has more complications so it is suggested only in selected cases. Operation should be amended with postoperative bursa omental lavage.
对于轻度急性胰腺炎，治疗基本为保守治疗，但在重症病例中，手术治疗起重要作用。
作者根据过去十年发表的文献分析手术指征、时机及相关技术问题。
无菌性胰腺坏死很少见，但如果保守治疗失败，感染性坏死是手术指征。对治疗有抵抗的多器官功能衰竭、腹腔间隔室综合征以及其他手术并发症如出血、穿孔需要手术治疗。在伴有胆汁淤积的胆源性胰腺炎中，建议紧急进行内镜下括约肌切开术，随后行胆囊切除术。对于胰腺坏死，理想的手术时间是疾病开始后的21天，因为早期手术并发症和死亡率较高。仔细的坏死组织清除术很重要，且必须延伸至结肠后和十二指肠后区域。开放性腹部手术并发症更多，因此仅在特定病例中建议使用。术后应进行网膜囊灌洗以完善手术。
