Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Curr Opin Gastroenterol. 2019 Sep;35(5):478-482. doi: 10.1097/MOG.0000000000000564.
To review the current management of walled-off pancreatic necrosis (WOPN).
The management of WOPN has evolved. Many collections do not require intervention and may resolve over time. Nutritional support and treatment of infection are two critical components of medical management. For collections requiring drainage, minimally invasive endoscopic therapies now play a primary role. Endoscopic transmural puncture with stent placement may provide access for drainage and decompression. More complex collections may require transluminal instrumentation with lavage, debridement, and necrosectomy. Concurrent pancreatic duct injuries including strictures, leaks, and disconnections are very common. Addressing the pancreatic ductal injury is a key component in the long-term success of management strategies. Providing high-level care for patients requires a multidisciplinary approach with providers specialized in the management of severe acute pancreatitis and associated complications.
Minimally invasive management strategies improve the outcomes for patients with WOPN. Close follow-up, medical therapy, and nutritional support are required for most patients. Endoscopic transmural drainage and necrosectomy are the primary approaches for collections requiring intervention. Protocols for endoscopic drainage are being refined to reduce side effects and decrease the number of interventions required for resolution.
回顾胰腺假性囊肿（WOPN）的当前治疗方法。
WOPN 的治疗方法已经发展。许多积聚物不需要干预，可能会随着时间的推移而自行解决。营养支持和感染治疗是医学管理的两个关键组成部分。对于需要引流的积聚物，微创内镜治疗现在发挥着主要作用。内镜经壁穿刺置管引流可提供引流和减压的途径。更复杂的积聚物可能需要经内镜器械进行灌洗、清创和坏死组织清除术。同时存在的胰腺管损伤，包括狭窄、渗漏和断开，非常常见。解决胰腺管损伤是管理策略长期成功的关键组成部分。为患者提供高水平的护理需要多学科方法，提供者应专门擅长重症急性胰腺炎及其相关并发症的管理。
微创管理策略可改善 WOPN 患者的预后。大多数患者需要密切随访、药物治疗和营养支持。对于需要干预的积聚物，内镜经壁引流和坏死组织清除术是主要方法。正在制定内镜引流方案以减少副作用并减少解决积聚物所需的干预次数。
