Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland.
Dig Surg. 2012;29(6):475-6. doi: 10.1159/000345620. Epub 2013 Jan 16.
The conservative treatment of acute necrotizing pancreatitis has greatly improved due to broad antibiotic treatment and improved organ support in intensive care units. Nevertheless, infected necrosis or persistent multi-organ dysfunction are predictors of poor outcome. In these patients, there is still a need to perform necrosectomy. Open surgery results in extensive operative trauma and is associated with high morbidity and mortality. Therefore, several minimally invasive techniques have been developed recently. Retroperitoneal necrosectomy has been shown to be safe and to reduce morbidity and mortality compared to the open procedure.
In an instructive video, we show the technique of video-assisted retroperitoneal necrosectomy with minimal access, including the preoperative percutaneous drainage and several accesses to the necrosis. We discuss the indication for retroperitoneal necrosectomy as well as the optimal time point of the intervention.
In the management of acute necrotizing pancreatitis, the multidisciplinary approach is crucial. The initial treatment by the intensive care units should be extended to intervention or surgery in case of infected necrosis or persistent multi-organ dysfunction. We show here a minimal access solution with the placement of a percutaneous drain followed by video-assisted retroperitoneal necrosectomy.
由于广谱抗生素治疗和重症监护病房中器官支持的改善，急性坏死性胰腺炎的保守治疗有了很大的进步。然而，感染性坏死或持续多器官功能障碍是预后不良的预测因素。在这些患者中，仍然需要进行坏死组织清除术。开放性手术会导致广泛的手术创伤，并伴有较高的发病率和死亡率。因此，最近已经开发了几种微创技术。与开放性手术相比，经腹膜后坏死组织清除术已被证明是安全的，并且可以降低发病率和死亡率。
在一个教学视频中，我们展示了微创经腹膜后坏死组织清除术的技术，包括术前经皮引流和对坏死组织的多次进入。我们讨论了经腹膜后坏死组织清除术的适应证以及干预的最佳时间点。
在急性坏死性胰腺炎的治疗中，多学科方法至关重要。重症监护病房的初始治疗应扩展到感染性坏死或持续多器官功能障碍的介入或手术治疗。我们在这里展示了一种微创解决方案，即放置经皮引流管，然后进行视频辅助经腹膜后坏死组织清除术。
