Jakobsen H L, Henriksen F W
Kirurgisk-gastroenterologisk afdeling D., Amtssygehuset i Gentofte.
Ugeskr Laeger. 1995 Oct 2;157(40):5534-7.
Acute pancreatitis is in the majority of patients a mild, self-limiting illness. Five to fifteen percent of the patients develop acute necrotizing pancreatitis, a severe illness with a high morbidity and mortality. Secondary infection of the pancreatic necrosis (infected pancreatic necrosis) is the main cause of death. Pancreatic necrosis is identified with a high accuracy by contrast-enhanced computed tomography. The differentiation between sterile and infected necrosis requires demonstration of bacteria or fungi isolated from the necrosis. Surgical treatment of a sterile necrosis remains controversial, but there is a tendency towards conservative non-operative treatment. Infected pancreatic necrosis is regarded as an absolute indication for surgery, untreated the mortality is approximately 100%. The aim of modern treatment is to remove the pancreatic necrosis continuously. This has successfully been done by the open packing method, with or without subsequent drainage. At present no randomized trials comparing the different treatment modalities are available. The question of prophylactic antibiotics still remains unanswered. For the present imipenem 0,5 g x 3 is recommended.
在大多数患者中，急性胰腺炎是一种轻度的自限性疾病。5%至15%的患者会发展为急性坏死性胰腺炎，这是一种具有高发病率和死亡率的严重疾病。胰腺坏死的继发感染（感染性胰腺坏死）是主要死因。通过增强计算机断层扫描能高度准确地识别胰腺坏死。无菌性坏死与感染性坏死的鉴别需要从坏死组织中分离出细菌或真菌。无菌性坏死的手术治疗仍存在争议，但有倾向于采用保守的非手术治疗。感染性胰腺坏死被视为手术的绝对指征，若不治疗，死亡率约为100%。现代治疗的目标是持续清除胰腺坏死组织。这已通过开放填塞法成功实现，可伴有或不伴有后续引流。目前尚无比较不同治疗方式的随机试验。预防性抗生素的问题仍未得到解答。目前推荐使用亚胺培南0.5克×3次。
