Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh, PA, USA.
Expert Rev Gastroenterol Hepatol. 2012 Dec;6(6):745-53. doi: 10.1586/egh.12.48.
Pancreatic necrosis is a local complication of severe acute pancreatitis associated with multiple organ dysfunction, infection and increased mortality. While surgery is the mainstay for invasive management, studies have demonstrated that delaying necrosectomy translates to improved patient outcomes. Minimally invasive therapies have been described both for early and late management of necrotic pancreatic collections and fall into three broad categories: endoscopic, radiology assisted percutaneous drainage and laparoscopic or retroperitoneal surgical techniques. Such interventions may serve as temporizing measures delaying necrosectomy, but more importantly, as best demonstrated in recent randomized controlled trials, can serve as alternative approaches resulting in improved patient outcomes. Access to these techniques is based on their availability at expert centers. Minimally invasive therapies have increased in popularity, with a general consensus among experts being that reduced complications and mortality rates are realized by approaches other than open necrosectomy. However, additional well-designed, randomized trials are needed.
胰腺坏死是重症急性胰腺炎的局部并发症，与多器官功能障碍、感染和死亡率增加有关。虽然手术是侵袭性治疗的主要手段，但研究表明，延迟坏死切除术可改善患者预后。微创治疗方法已被描述用于早期和晚期处理坏死性胰腺积聚，并分为三大类：内镜、放射学辅助经皮引流以及腹腔镜或腹膜后外科技术。这些干预措施可能是延迟坏死切除术的临时措施，但更重要的是，正如最近的随机对照试验所证明的那样，它们可以作为替代方法，改善患者的预后。这些技术的应用取决于在专家中心的可用性。微创治疗方法越来越受欢迎，专家普遍认为，通过开放坏死切除术以外的方法可以降低并发症和死亡率。然而，还需要更多设计良好的随机试验。
