Windsor John A, Escott Alistair, Brown Lisa, Phillips Anthony Rj
Pancreas Research Group, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
J Gastroenterol Hepatol. 2017 Nov;32(11):1796-1803. doi: 10.1111/jgh.13784.
Acute pancreatitis (AP) is a common disease for which a specific treatment remains elusive. The key determinants of the outcome from AP are persistent organ failure and infected pancreatic necrosis. The prevention and treatment of these determinants provides a framework for the development of specific treatment strategies. The gut-lymph concept provides a common mechanism for systemic inflammation and organ dysfunction. Acute and critical illness, including AP, is associated with intestinal ischemia and drastic changes in the composition of gut lymph, which bypasses the liver to drain into the systemic circulation immediately proximal to the major organ systems which fail. The external diversion of gut lymph and the targeting of treatments to counter the toxic elements in gut lymph offers novel approaches to the prevention and treatment of persistent organ failure. Infected pancreatic necrosis is increasingly treated with less invasive techniques, the mainstay of which is drainage, both endoscopic and percutaneous. Further improvements will occur with the strategies to accelerate liquefaction and through a fundamental re-design of drains, both of which will increase drainage efficacy. The determinants of severity and outcome in patients admitted with AP provide the basis for innovative treatment strategies. The priorities are to translate the gut-lymph concept to clinical practice and to improve the design and active use of drains for infected complications of AP.
急性胰腺炎（AP）是一种常见疾病，目前仍缺乏特效治疗方法。AP预后的关键决定因素是持续性器官功能衰竭和感染性胰腺坏死。对这些决定因素的预防和治疗为制定具体治疗策略提供了框架。肠-淋巴概念为全身炎症和器官功能障碍提供了一个共同机制。包括AP在内的急性和危重病与肠道缺血以及肠淋巴成分的剧烈变化有关，肠淋巴绕过肝脏，直接排入紧邻发生功能衰竭的主要器官系统的体循环。肠淋巴的体外引流以及针对肠淋巴中毒性成分的治疗靶点为预防和治疗持续性器官功能衰竭提供了新方法。感染性胰腺坏死越来越多地采用侵入性较小的技术进行治疗，其中主要是内镜和经皮引流。通过加速液化的策略以及对引流管进行根本性重新设计，这两方面都将提高引流效果，从而带来进一步改善。AP患者病情严重程度和预后的决定因素为创新治疗策略提供了依据。当务之急是将肠-淋巴概念转化为临床实践，并改进AP感染性并发症引流管的设计和积极应用。
