胰管断裂或断开的诊断和治疗：国际专家调查和病例描述研究。
Diagnosis and treatment of pancreatic duct disruption or disconnection: an international expert survey and case vignette study.
机构信息
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
出版信息
HPB (Oxford). 2021 Aug;23(8):1201-1208. doi: 10.1016/j.hpb.2020.11.1148. Epub 2021 Jan 19.
BACKGROUND
Pancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis. With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice. We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study.
METHODS
An online case vignette survey was sent to 110 international expert pancreatologists. Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis. Consensus was defined as agreement by at least 75% of the experts.
RESULTS
The response rate was 51% (n = 56). Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity. The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43). Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis.
CONCLUSION
This international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation.
背景
胰腺管破裂或断开是坏死性胰腺炎的一种潜在严重并发症。由于没有现有的治疗指南，目前尚不清楚临床实践中的专家是否存在共识。我们通过一项国际病例 vignette 研究评估了当前关于胰腺管破裂和断开的诊断和治疗的专家意见。
方法
我们向 110 名国际专家胰腺病学家发送了一份在线病例 vignette 调查。专家的选择基于过去 5 年的出版物和/或参与制定 IAP/APA 和 ESGE 急性胰腺炎指南。共识的定义是至少 75%的专家同意。
结果
回复率为 51%（n=56）。44 名专家（79%）获得了 MRI/MRCP，52 名专家（93%）测量了经皮引流液中的淀粉酶水平，以评估胰腺管的完整性。大多数专家赞成内镜经腔引流治疗感染性（胰周）坏死和胰腺管破裂（84%，n=45）或断开（88%，n=43）。对于持续经皮引流产生和持续无菌性坏死的患者的治疗，存在共识缺失。
结论
这项针对专家的国际调查表明，存在许多尚未达成共识的领域，为未来的研究提供了明确的重点。
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