Xiao Nian-Jun, Cui Ting-Ting, Liu Fang, Li Wen
Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China.
Department of Gastroenterology and Hepatology, Medical School of Chinese People's Liberation Army, Beijing 100853, China.
World J Gastrointest Surg. 2021 Jul 27;13(7):633-644. doi: 10.4240/wjgs.v13.i7.633.
Pancreatic and peripancreatic collections are the main local complications of acute pancreatitis with a high incidence. In the early phase, most acute pancreatic and peripancreatic collections can resolve spontaneously with supportive treatment. However, in some cases, they will develop into pancreatic pseudocyst (PPC) or walled-off necrosis (WON). When causing symptoms or coinfection, both PPC and WON may require invasive intervention. Compared to PPC, which can be effectively treated by endoscopic ultrasound-guided transmural drainage with plastic stents, the treatment of WON is more complicated and challenging, particularly in the presence of infected necrosis. In the past few decades, with the development of minimally invasive interventional technology especially the progression of endoscopic techniques, the standard treatments of those severe complications have undergone tremendous changes. Currently, based on the robust evidence from randomized controlled trials, the step-up minimally invasive approaches have become the standard treatments for WON. However, the pancreatic fistulae during the surgical step-up treatment and the stent-related complications during the endoscopic step-up treatment should not be neglected. In this review article, we will mainly discuss the indications of PPC and WON, the timing for intervention, and minimally invasive treatment, especially endoscopic treatment. We also introduced our preliminary experience in endoscopic gastric fenestration, which may be a promising innovative method for the treatment of WON.
胰腺及胰周积液是急性胰腺炎常见的主要局部并发症。在疾病早期，多数急性胰腺及胰周积液通过支持治疗可自行消退。然而，在某些情况下，它们会发展为胰腺假性囊肿（PPC）或包裹性坏死（WON）。当PPC和WON引发症状或合并感染时，可能均需进行有创干预。与可通过内镜超声引导下经壁置入塑料支架引流有效治疗的PPC相比，WON的治疗更为复杂且具有挑战性，尤其是存在感染性坏死时。在过去几十年中，随着微创介入技术的发展，特别是内镜技术的进步，这些严重并发症的标准治疗方法发生了巨大变化。目前，基于随机对照试验的有力证据，逐步升级的微创方法已成为WON的标准治疗方案。然而，手术逐步升级治疗过程中的胰瘘以及内镜逐步升级治疗过程中的支架相关并发症不容忽视。在这篇综述文章中，我们将主要讨论PPC和WON的适应证、干预时机以及微创治疗，尤其是内镜治疗。我们还介绍了内镜下胃开窗术的初步经验，这可能是一种有前景的创新治疗WON的方法。
