García García de Paredes Ana, López-Durán Sergio, Foruny Olcina José Ramón, Albillos Agustín, Vázquez-Sequeiros Enrique
Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal. Unviersidad de Alcalá. IRYICIS, España.
Rev Esp Enferm Dig. 2020 Jun;112(6):483-490. doi: 10.17235/reed.2020.6814/2019.
Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage.
胰腺液体积聚常见于中度和重度急性胰腺炎，也可能作为慢性胰腺炎、胰腺手术或创伤的并发症出现。必须遵循亚特兰大分类命名法，将其细分为四类（急性胰周液体积聚、急性坏死性积聚、假性囊肿和包裹性坏死），因为这会影响预后和治疗。假性囊肿和包裹性胰腺坏死是有包膜的胰腺液体积聚，其特征是周围有炎性壁，通常在急性胰腺炎发作后三到四周形成。大多数胰腺液体积聚可自行消退，无需干预。然而，当它们出现症状或需要进行复杂引流时，内镜超声引导下引流已成为有包膜积聚的一线治疗方法。由于假性囊肿的内容物为液体，其引流相对简单。然而，在包裹性坏死中，固体坏死碎片的存在会使治疗更具挑战性，因此建议在经验丰富的中心进行多学科管理，逐步升级方法是目前的标准治疗方案。在本综述中，我们旨在探讨胰腺液体积聚的管理，特别关注内镜引流。
