Mirza-Aghazadeh-Attari Mohammad, Zakavi Seyed Sina, Ghabili Kamyar, Harfouche Melike N, Jha Reena, Camacho Juan C, Shaikh Jamil, Radkani Pejman, Chalhoub Walid M, Ozen Merve, Habibollahi Peiman, Smirniotopoulos John B, Nezami Nariman
Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland.
Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Semin Intervent Radiol. 2025 Jan 6;42(1):82-92. doi: 10.1055/s-0044-1801358. eCollection 2025 Feb.
Acute pancreatitis (AP) is a severe inflammatory condition of the pancreas with significant morbidity and mortality, particularly in its necrotizing form. This review explores the management of peripancreatic collections and in particular necrotizing pancreatitis, focusing on the evolution from traditional open surgical methods to contemporary minimally invasive image-guided techniques. AP can lead to various local complications, including pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Imaging plays a crucial role in diagnosing complications of AP, while treatment approaches have shifted toward a step-up strategy involving percutaneous, endoscopic, and minimally invasive methods. Percutaneous necrosectomy, combining mechanical and chemical debridement, has shown promising results. Mechanical necrosectomy uses devices like baskets and retrieval nets, while chemical necrosectomy adds agents like hydrogen peroxide and streptokinase. Current evidence suggests that the step-up approach, starting with percutaneous drainage or necrosectomy and escalating to endoscopic or surgical interventions, if necessary, improves patient outcomes. The review underscores the need for a multidisciplinary approach in managing complicated AP and highlights ongoing advancements in minimally invasive techniques.
急性胰腺炎（AP）是胰腺的一种严重炎症性疾病，具有较高的发病率和死亡率，尤其是坏死性胰腺炎。本综述探讨胰腺周围积液的管理，特别是坏死性胰腺炎，重点关注从传统开放手术方法到当代微创影像引导技术的演变。AP可导致各种局部并发症，包括胰腺假性囊肿、急性坏死性积液和包裹性坏死。影像学在诊断AP并发症中起着关键作用，而治疗方法已转向包括经皮、内镜和微创方法的逐步升级策略。经皮坏死组织清除术，结合机械和化学清创，已显示出有前景的结果。机械坏死组织清除术使用如篮筐和回收网等器械，而化学坏死组织清除术则添加如过氧化氢和链激酶等药物。目前的证据表明，逐步升级方法，从经皮引流或坏死组织清除术开始，必要时升级到内镜或手术干预，可改善患者预后。该综述强调了在管理复杂性AP时采用多学科方法的必要性，并突出了微创技术的持续进展。
