Zheng Zhi, Ding Yi-Xuan, Qu Yuan-Xu, Cao Feng, Li Fei
Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Jan;9(1):69. doi: 10.21037/atm-20-4802.
Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and "step-up" approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients' quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.
急性胰腺炎（AP）是一种炎症性疾病，可进展为重症急性胰腺炎（SAP），从而增加死亡风险。AP的特征是胰蛋白酶原的不适当激活、炎症细胞浸润以及分泌细胞的破坏。其他促成因素可能包括钙（Ca）超载、线粒体功能障碍、自噬受损和内质网（ER）应激。此外，外泌体也与许多人类疾病的病理生理过程相关，可能在AP中发挥生物学作用。然而，其发病机制尚未完全阐明，需要进一步探索以指导治疗。最近，治疗指南发生了变化；作为核心的多学科参与和“递进式”方法，更提倡微创治疗。手术方式已逐渐从开放手术转变为微创手术，主要包括经皮导管引流（PCD）、内镜检查、小切口手术和电视辅助手术。目前AP的管理指南已在许多方面进行了更新和修订。液体复苏中使用的液体类型、给药的时机、体积和速度一直存在争议。此外，营养支持和预防性抗生素治疗的时机和作用，以及手术或内镜干预的时机，以及并发症的管理仍有许多不确定性，可能会对预后和患者的生活质量产生负面影响。因此，为了让临床医生了解最佳治疗方法，我们旨在综述对AP发病机制及其诊断和管理的最新认识进展。
