Ben-Ami Shor Dana, Ritter Einat, Borkovsky Tom, Santo Erwin
Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2025 Apr 23;14(9):2904. doi: 10.3390/jcm14092904.
Acute pancreatitis is a common gastrointestinal condition, primarily caused by gallstones and alcohol abuse, with other causes including hypertriglyceridemia, trauma, infections, etc. While most cases are mild and self-limiting, up to 20% of patients develop severe pancreatitis with pancreatic necrosis, increasing the risk of multi-organ failure and mortality. Conservative management involves fluid resuscitation, nutritional support, and antibiotics for infected peripancreatic fluid collections (PFCs). When PFCs are infected or symptoms persist, invasive interventions such as endoscopic ultrasound (EUS)-guided drainage or percutaneous drainage are recommended. Dual modalities (endoscopic and percutaneous drainage) offer better outcomes with fewer complications. Direct endoscopic necrosectomy is considered for patients who do not improve with drainage. A multidisciplinary team, including endoscopists, interventional radiologists, surgeons, and specialists, is essential for optimal management of severe necrotizing pancreatitis.
急性胰腺炎是一种常见的胃肠道疾病，主要由胆结石和酗酒引起，其他病因包括高甘油三酯血症、创伤、感染等。虽然大多数病例病情较轻且具有自限性，但高达20%的患者会发展为伴有胰腺坏死的重症胰腺炎，增加多器官功能衰竭和死亡风险。保守治疗包括液体复苏、营养支持以及针对感染性胰周液体积聚（PFCs）使用抗生素。当PFCs发生感染或症状持续时，建议采取侵入性干预措施，如内镜超声（EUS）引导下引流或经皮引流。联合治疗方式（内镜和经皮引流）能带来更好的治疗效果且并发症更少。对于经引流治疗后病情无改善的患者，可考虑直接内镜坏死组织清除术。一个包括内镜医师、介入放射科医生、外科医生和专科医生在内的多学科团队对于重症坏死性胰腺炎的最佳管理至关重要。
