Department of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA 02114, United States.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States.
World J Gastroenterol. 2022 Jul 21;28(27):3383-3397. doi: 10.3748/wjg.v28.i27.3383.
Acute pancreatitis (AP) is one of the most common gastrointestinal diseases and remains a life-threatening condition. Although AP resolves to restitutio ad integrum in approximately 80% of patients, it can progress to necrotizing pancreatitis (NP). NP is associated with superinfection in a third of patients, leading to an increase in mortality rate of up to 40%. Accurate and early diagnosis of NP and associated complications, as well as state-of-the-art therapy are essential to improve patient prognoses. The emerging role of endoscopy and recent trials on multidisciplinary management of NP established the "step-up approach". This approach starts with endoscopic interventions and can be escalated to other interventional and ultimately surgical procedures if required. Studies showed that this approach decreases the incidence of new multiple-organ failure as well as the risk of interventional complications. However, the optimal interventional sequence and timing of interventional procedures remain controversial. This review aims to summarize the indications, timing, and treatment outcomes for infected NP and to provide guidance on multidisciplinary decision-making.
急性胰腺炎（AP）是最常见的胃肠道疾病之一，仍然是一种危及生命的疾病。尽管约 80%的患者的 AP 可恢复至完全正常，但它可能进展为坏死性胰腺炎（NP）。NP 可导致三分之一的患者发生继发感染，死亡率高达 40%。准确和早期诊断 NP 及其相关并发症，以及采用最先进的治疗方法对于改善患者预后至关重要。内镜的新作用和 NP 多学科管理的最新试验确立了“逐步升级方法”。这种方法首先进行内镜干预，如果需要，可升级为其他介入性治疗，最终可进行手术。研究表明，这种方法可降低新发多器官功能衰竭的发生率以及介入并发症的风险。然而，最佳介入顺序和介入时机仍存在争议。本文旨在总结感染性 NP 的适应证、时机和治疗结果，并为多学科决策提供指导。
