Debas H T
J Assoc Acad Minor Phys. 1989;1(1):24-9.
No major breakthrough has occurred in our understanding of the etiology or pathogenesis of acute pancreatitis. However, significant advances in management of the disease have resulted in improved survival. These include disease severity assessment by Ranson's criteria or by similar other clinical methods, as well as by computerized tomography (CT). The use of contrast-enhanced CT has made possible early diagnosis of pancreatic necrosis by showing areas of hypoperfusion. Once the presence of necrosis is established, CT-guided needle aspiration of necrotic tissue can be performed for gram stain and for culture of bacteria. This approach makes possible earlier diagnosis of pancreatic sepsis, and hence earlier surgery. Other important contributions have been radiologic and endoscopic interventional techniques. Percutaneous catheter drainage of rapidly enlarging acute pseudocysts can obviate the serious complication of free rupture of pseudocysts into the peritoneal cavity; similar drainage of infected pseudocysts may also provide a definitive or at least a palliative therapy. Bleeding from eroded vessels, false aneurysms or pseudocysts can often be successfully controlled by selective angiography. In severe acute biliary pancreatitis, endoscopic sphincterotomy within 72 hours of admission has been shown to reduce morbidity, mortality, and hospital stay. These interventional techniques permit surgery to be postponed until the most optimal time. The advances cited above, as well as improved intensive care and nutritional management, are beginning to reduce the high mortality of severe acute pancreatitis.
在我们对急性胰腺炎的病因或发病机制的理解方面尚未取得重大突破。然而，在该疾病的管理方面取得的显著进展已使生存率得到提高。这些进展包括通过兰森标准或其他类似的临床方法以及计算机断层扫描（CT）进行疾病严重程度评估。使用增强CT通过显示灌注不足区域使得早期诊断胰腺坏死成为可能。一旦确定存在坏死，就可以进行CT引导下的坏死组织针吸活检，以进行革兰氏染色和细菌培养。这种方法使得早期诊断胰腺脓毒症成为可能，从而可以更早地进行手术。其他重要贡献是放射学和内镜介入技术。经皮导管引流迅速增大的急性假性囊肿可避免假性囊肿向腹腔内自由破裂这一严重并发症；对感染性假性囊肿进行类似的引流也可提供确定性或至少是姑息性治疗。由糜烂血管、假性动脉瘤或假性囊肿引起的出血通常可通过选择性血管造影成功控制。在重症急性胆源性胰腺炎中，入院72小时内进行内镜括约肌切开术已被证明可降低发病率、死亡率和住院时间。这些介入技术使手术能够推迟到最适宜的时机进行。上述进展以及改善的重症监护和营养管理，正开始降低重症急性胰腺炎的高死亡率。
