Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA.
Expert Rev Gastroenterol Hepatol. 2013 Jul;7(5):463-75. doi: 10.1586/17474124.2013.811055.
The management of necrotizing pancreatitis has undergone a paradigm shift toward minimally invasive techniques for necrosectomy, obviating the need for open necrosectomy in most cases. There is increasing evidence that minimally invasive approaches including a step-up approach that incorporates percutaneous catheter or endoscopic transluminal drainage, followed by video-assisted retroperitoneal or endoscopic debridement are associated with improved outcomes over traditional open necrosectomy for patients with infected necrosis. A recent international multidisciplinary consensus conference emphasized the superiority of minimally invasive approaches over standard surgical approaches. The success of these techniques depends on concerted efforts of a multidisciplinary team of interventional endoscopists, radiologists, intensivists and surgeons dedicated to the management of severe acute pancreatitis and its complications. This review provides an overview of minimally invasive techniques for management of necrotizing pancreatitis, including indications, timing, advantages and disadvantages.
坏死性胰腺炎的治疗已经发生了重大转变，微创技术（如经皮导管或内镜经腔引流，随后行视频辅助腹膜后或内镜清创术）用于坏死组织清除术，在大多数情况下已经取代了开放性坏死组织清除术。越来越多的证据表明，微创方法（包括逐步采用经皮导管或内镜经腔引流，随后行视频辅助腹膜后或内镜清创术）与传统的开放性坏死组织清除术相比，对于感染性坏死患者的预后有改善作用。最近的一次国际多学科共识会议强调了微创方法相对于标准手术方法的优越性。这些技术的成功取决于介入内镜医生、放射科医生、重症监护医生和外科医生组成的多学科团队的共同努力，致力于严重急性胰腺炎及其并发症的管理。这篇综述提供了坏死性胰腺炎微创治疗技术的概述，包括适应证、时机、优缺点。
