Farthmann E H, Lausen M, Schöffel U
Department of Surgery, University of Freiburg, Germany.
Hepatogastroenterology. 1993 Dec;40(6):556-62.
The clinical spectrum of acute pancreatitis ranges from mild, self-limiting symptoms to fulminant illness that may rapidly lead to multiple organ failure and death. Differentiation between acute interstitial pancreatitis, necrotizing pancreatitis, pancreatic abscess and acute pseudocyst is mandatory for the choice of surgical treatment. If morphological evaluation by dynamic pancreatography reveals pancreatic or peripancreatic necrosis, bacteriological evaluation by CT-guided fine-needle aspiration is the mainstay of further decision-making, and should be performed if general signs of inflammation are not improved by conservative therapy. Basically, operative treatment may be directed against underlying pathology (e.g. cholelithiasis), or may aim to manage complications. Infected necrosis is the only clear indication for surgery. Whether the choice should be debridement and gravity drainage, continuous closed lavage of the lesser sac, staged relaparotomies, or open packing, depends on the extent of the process and the individual situation. Peripancreatic fluid collections and pancreatic pseudocysts without major ductal pathology rarely need operative treatment in the early stages, whereas abscesses resulting from infected necrosis should be dealt with by surgery rather than by percutaneous drainage.
急性胰腺炎的临床谱范围从轻度、自限性症状到暴发性疾病，后者可能迅速导致多器官功能衰竭和死亡。对于手术治疗的选择，区分急性间质性胰腺炎、坏死性胰腺炎、胰腺脓肿和急性假性囊肿至关重要。如果动态胰腺造影的形态学评估显示胰腺或胰周坏死，那么通过CT引导下细针穿刺进行细菌学评估是进一步决策的主要依据，并且如果保守治疗后炎症的一般体征没有改善，就应该进行此项检查。基本上，手术治疗可以针对潜在病因（如胆石症），也可以旨在处理并发症。感染性坏死是唯一明确的手术指征。选择清创及重力引流、小网膜囊持续闭式灌洗、分期再次剖腹手术还是开放填塞，取决于病变范围和个体情况。胰周液体积聚和无主胰管病变的胰腺假性囊肿在早期很少需要手术治疗，而感染性坏死导致的脓肿应该通过手术而非经皮引流来处理。
