Basile Guido, Vacante Marco, Corsaro Antonino, Evola Francesco R, Maugeri Grazia, Barchitta Martina, Biondi Antonio, Musumeci Giuseppe, D'Agata Velia, Evola Giuseppe
Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy -
Unit of Internal Medicine Critical Area, Garibaldi Hospital, Catania, Italy.
Minerva Surg. 2025 Jun;80(3):236-257. doi: 10.23736/S2724-5691.25.10773-9. Epub 2025 May 22.
Acute pancreatitis (AP) is a potentially life-threatening inflammatory condition characterized by localized pancreatic damage and the activation of the inflammatory cascade, leading to systemic inflammatory response syndrome (SIRS). This complex disease often presents with a variable and unpredictable course. The primary causes of AP include the migration of gallstones and alcohol consumption. The Revised Atlanta Classification 2012 (RAC) is the most widely utilized classification system for AP, distinguishing between interstitial edematous pancreatitis and necrotizing pancreatitis, three severity levels and an early and a late phase. Severe AP carries a high risk of mortality. Currently, there is no definitive prognostic score for accurately predicting severe cases of AP. Initial management focuses on supportive care, applicable to both mild and severe forms of the disease, while later management addresses complications associated with severe AP. Although there is no consensus on the optimal type or regimen of fluids for resuscitation, goal-directed fluid therapy, particularly with Ringer's lactate, has been linked to improved outcomes. Prophylactic antibiotics have not proven effective in preventing infectious complications associated with AP. Patients experiencing mild acute gallstone pancreatitis should be advised to undergo laparoscopic cholecystectomy during their initial admission, whereas those with severe gallstone pancreatitis and signs of cholangitis or choledocholithiasis may benefit from early endoscopic retrograde cholangiopancreatography (ERCP). The management of severe AP complications has evolved from an early surgical approach to a minimally invasive step-up strategy, which is now considered the standard intervention.
急性胰腺炎（AP）是一种潜在危及生命的炎症性疾病，其特征为胰腺局部损伤和炎症级联反应激活，进而导致全身炎症反应综合征（SIRS）。这种复杂疾病的病程往往多变且不可预测。AP的主要病因包括胆结石移动和饮酒。2012年修订的亚特兰大分类法（RAC）是应用最广泛的AP分类系统，可区分间质水肿性胰腺炎和坏死性胰腺炎、三个严重程度级别以及早期和晚期。重症AP具有较高的死亡风险。目前，尚无准确预测重症AP病例的确定性预后评分。初始治疗重点为支持治疗，适用于疾病的轻度和重度形式，而后期治疗则针对与重症AP相关的并发症。尽管对于复苏所用液体的最佳类型或方案尚无共识，但目标导向性液体治疗，尤其是使用乳酸林格氏液，已被证明可改善预后。预防性抗生素在预防与AP相关的感染性并发症方面尚未证实有效。对于轻度急性胆石性胰腺炎患者，建议在首次住院期间接受腹腔镜胆囊切除术，而对于重症胆石性胰腺炎且有胆管炎或胆总管结石迹象的患者，早期内镜逆行胰胆管造影术（ERCP）可能有益。重症AP并发症的治疗已从早期手术方法演变为微创递进策略，目前该策略被视为标准干预措施。
