van Brunschot Sandra, van Santvoort Hjalmar C, Gooszen Hein G, Fockens Paul
Universitair Medisch Centrum St Radboud, afd. OK/evidence based surgery, Nijmegen, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(4):A4329.
In patients with infected necrotising pancreatitis there is a significant risk (40%) of complications and mortality with the surgical step-up approach. This approach consists of percutaneous retroperitoneal drainage, if necessary followed by video-assisted retroperitoneal débridement. An alternative treatment is an endoscopic step-up approach consisting of endoscopic transluminal drainage, if necessary followed by endoscopic transluminal necrosectomy. The Dutch Pancreatitis Study Group has recently started the nationwide randomized TENSION-trial, in which in 98 patients the endoscopic step-up approach is compared with the surgical method. The primary endpoint is a composite of mortality and major morbidity (new onset organ failure, bleeding, perforation of a hollow organ or incisional hernia for which intervention is needed).
在感染性坏死性胰腺炎患者中，采用逐步升级手术治疗方法时，出现并发症和死亡的风险显著（40%）。该方法包括经皮腹膜后引流，必要时随后进行电视辅助腹膜后清创术。另一种治疗方法是逐步升级的内镜治疗方法，包括内镜腔内引流，必要时随后进行内镜腔内坏死组织清除术。荷兰胰腺炎研究小组最近启动了全国性的随机TENSION试验，在98例患者中比较内镜逐步升级治疗方法与手术方法。主要终点是死亡率和严重并发症（新发器官衰竭、出血、中空器官穿孔或需要干预的切口疝）的综合指标。
