Suppr超能文献

急性胰腺炎的内镜介入治疗:高级内镜医师想知道的内容

Endoscopic Interventions in Acute Pancreatitis: What the Advanced Endoscopist Wants to Know.

机构信息

From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.).

出版信息

Radiographics. 2018 Nov-Dec;38(7):2002-2018. doi: 10.1148/rg.2018180066. Epub 2018 Sep 28.

Abstract

Endoscopic interventions play an important role in the modern management of pancreatic fluid collections. Successful management of pancreatitis is dependent on proper classification of the disease and its local complications. The 2012 revised Atlanta classification divides acute pancreatitis into subtypes of necrotizing pancreatitis and interstitial edematous pancreatitis (IEP) on the basis of the radiologic presence or absence of necrosis, respectively. Local complications of IEP include acute pancreatic fluid collections and pseudocysts, which contain fluid only and are differentiated by the time elapsed since the onset of symptoms. Local complications of necrotizing pancreatitis include acute necrotic collections and walled-off necrosis, which contain nonliquefied necrotic debris and are differentiated by the time elapsed since the onset of symptoms. Endoscopic techniques are used to treat local complications of pancreatitis, often in a step-up approach, by which less invasive techniques are preferred initially with potential subsequent use of more invasive procedures, dependent on the patient's clinical response and collection evolution. Common interventions performed by the advanced endoscopist include endoscopic transmural drainage and endoscopic transmural necrosectomy. However, some collections require a multimodal approach with adjunctive placement of percutaneous drainage catheters or the use of videoscopic-assisted retroperitoneal débridement. Additional endoscopic interventions may be required in the setting of pancreatic or biliary duct stones or strictures. Common complications of endoscopic intervention in the setting of pancreatitis include bleeding, infection, perforation, and stent migration. This article reviews the classification of acute pancreatitis, familiarizes radiologists with the common endoscopic techniques used in its management, and improves identification of the clinically relevant imaging findings and procedural complications related to endoscopic interventions in pancreatitis. RSNA, 2018.

摘要

内镜介入在胰腺液体积聚的现代治疗中起着重要作用。胰腺炎的成功治疗取决于对疾病及其局部并发症的正确分类。2012 年修订的亚特兰大分类法根据影像学上有无坏死将急性胰腺炎分为坏死性胰腺炎和间质性水肿性胰腺炎(IEP)两种亚型。IEP 的局部并发症包括急性胰腺液体积聚和假性囊肿,仅含液体,根据症状发作后时间的长短来区分。坏死性胰腺炎的局部并发症包括急性坏死性积聚和包裹性坏死,含有未液化的坏死组织碎片,根据症状发作后时间的长短来区分。内镜技术用于治疗胰腺炎的局部并发症,通常采用逐步升级的方法,即最初采用创伤较小的技术,随后根据患者的临床反应和积聚的演变情况,可能会使用更具侵袭性的程序。高级内镜医生常进行的常见干预措施包括内镜经壁引流和内镜经壁坏死组织清除术。然而,一些积聚需要多模态方法,辅助放置经皮引流导管或使用视频辅助腹膜后清创术。在存在胰胆管结石或狭窄的情况下,可能需要额外的内镜干预。胰腺炎内镜治疗的常见并发症包括出血、感染、穿孔和支架迁移。本文回顾了急性胰腺炎的分类,使放射科医生熟悉其治疗中常用的内镜技术,并提高对与胰腺炎内镜介入相关的临床相关影像学表现和程序并发症的识别能力。RSNA,2018 年。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验