Lumsden A, Bradley E L
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Surg Gynecol Obstet. 1990 May;170(5):459-67.
Infectious complications account for 80 per cent of the deaths resulting from acute pancreatitis. Future progress in the mortality of severe acute pancreatitis requires that we turn our attention toward the management of secondary pancreatic infections--abscess, infected pseudocyst and IPN. Review of 1,100 reported instances of secondary pancreatic infections reveals a pressing need for precise definitions of the individual infectious complication. In view of the marked discrepancy in definitions of disease between previous investigators, prior data must be seriously questioned, and doubt is cast upon long-standing recommendations for treatment. Recent advances in knowledge of the physiopathologic nature and diagnosis of secondary pancreatic infections promise improved surgical results. In particular, current diagnostic methods offer opportunities for more timely surgical intervention, avoiding the excessive mortality rate attendant upon delayed recognition. Furthermore, the use of condition-specific procedures, such as transcutaneous drainage for infected pseudocysts, débridement and sump drainage for pancreatic abscess and open drainage for IPN, may prove useful in combating the excessive morbidity and mortality rates caused by these conditions.
感染性并发症占急性胰腺炎所致死亡的80%。要降低重症急性胰腺炎的死亡率，未来我们必须将注意力转向继发性胰腺感染的管理，即脓肿、感染性假性囊肿和胰腺坏死感染（IPN）。回顾1100例报告的继发性胰腺感染病例发现，迫切需要对每种感染性并发症进行精确的定义。鉴于此前研究者对疾病的定义存在显著差异，之前的数据必须受到严肃质疑，长期以来的治疗建议也受到了怀疑。继发性胰腺感染的生理病理性质和诊断方面的最新知识进展有望改善手术效果。特别是，当前的诊断方法为更及时的手术干预提供了机会，避免了因诊断延迟而导致的过高死亡率。此外，采用针对具体病情的手术方法，如对感染性假性囊肿进行经皮引流、对胰腺脓肿进行清创和置管引流以及对IPN进行开放引流，可能有助于对抗这些病情所导致的过高发病率和死亡率。
