Vaidya Khushbu, Shinde Raju K, Nagtode Tushar, Jivani Ashish, Goel Somya, Samuel Joben
General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Researc, Wardha, IND.
Cureus. 2024 Sep 29;16(9):e70470. doi: 10.7759/cureus.70470. eCollection 2024 Sep.
Necrotizing pancreatitis (NP) is a severe complication of acute pancreatitis, characterized by necrosis of pancreatic and peripancreatic tissues, leading to significant morbidity and mortality. The role of necrosectomy, the surgical removal of necrotic tissue, in the management of NP has evolved over the past few decades, moving from early aggressive surgical intervention to a more conservative and stepwise approach. This narrative review explores the historical perspectives, current practices, and future trends in the role of necrosectomy in NP. Early studies favored open surgical debridement; however, high mortality rates associated with early intervention prompted a shift towards minimally invasive techniques, delayed interventions, and the "step-up approach," combining percutaneous drainage with minimally invasive surgery. We also review the indications for surgery, optimal timing, and various techniques, including video-assisted retroperitoneal debridement and endoscopic transluminal necrosectomy. The review highlights the benefits of these strategies in reducing complications, improving patient outcomes, and minimizing hospital stays. Ongoing research into patient selection, timing, and procedural refinement will continue to shape the role of necrosectomy in NP management. Understanding the evolving role of necrosectomy is crucial for optimizing care and reducing the burden of this life-threatening condition.
坏死性胰腺炎（NP）是急性胰腺炎的一种严重并发症，其特征为胰腺及胰腺周围组织坏死，可导致较高的发病率和死亡率。坏死组织切除术，即手术切除坏死组织，在NP治疗中的作用在过去几十年中不断演变，从早期积极的手术干预转向更为保守和循序渐进的方法。这篇叙述性综述探讨了坏死组织切除术在NP治疗中作用的历史观点、当前实践及未来趋势。早期研究倾向于开放手术清创；然而，与早期干预相关的高死亡率促使向微创技术、延迟干预以及“逐步升级法”转变，即将经皮引流与微创手术相结合。我们还回顾了手术指征、最佳时机及各种技术，包括电视辅助腹膜后清创术和内镜经腔坏死组织切除术。该综述强调了这些策略在减少并发症、改善患者预后及缩短住院时间方面的益处。对患者选择、时机及手术操作优化的持续研究将继续塑造坏死组织切除术在NP治疗中的作用。了解坏死组织切除术不断演变的作用对于优化治疗及减轻这种危及生命疾病的负担至关重要。
