Werner J, Büchler M W
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Heidelberg, Deutschland.
Chirurg. 2011 Jun;82(6):507-13. doi: 10.1007/s00104-010-2060-x.
Currently, patients with severe necrotizing pancreatitis rarely need interventional or surgical treatment. However, in case of pancreatic infection and septic complications they should be treated with the step up approach, primarily with an interventional or endoscopic drainage. If further clinical deterioration occurs necrosectomy is indicated. This should ideally be postponed until the third or fourth week after onset of pancreatitis to optimize surgical conditions including demarcation of the necrosis. Open necrosectomy with postoperative continuous lavage is a valid treatment option with low mortality, low morbidity and good long-term outcome. In recent years, several minimally invasive techniques for necrosectomy have been developed and are alternative approaches in about 70% of cases. In most cases, the retroperitoneoscopic approach is used, although the endoscopic transgastric route is also being used more and more frequently. While the reduced operative trauma should theoretically also reduce the onset of postoperative organ failure, no study has actually proven this.
目前，重症坏死性胰腺炎患者很少需要介入或手术治疗。然而，一旦发生胰腺感染和脓毒症并发症，应采用逐步升级的方法进行治疗，主要是进行介入或内镜引流。如果出现进一步的临床恶化，则需进行坏死组织清除术。理想情况下，应将其推迟到胰腺炎发作后的第三或第四周，以优化手术条件，包括坏死组织的分界。开放性坏死组织清除术加术后持续灌洗是一种有效的治疗选择，死亡率低、发病率低且长期效果良好。近年来，已开发出几种用于坏死组织清除术的微创技术，约70%的病例可采用这些替代方法。在大多数情况下，采用后腹腔镜入路，不过内镜经胃途径也越来越频繁地被使用。虽然理论上手术创伤的减少也应降低术后器官衰竭的发生率，但尚无研究实际证明这一点。
