Marshall J B
Department of Internal Medicine, University of Missouri School of Medicine, Columbia.
Arch Intern Med. 1993 May 24;153(10):1185-98. doi: 10.1001/archinte.153.10.1185.
The spectrum of acute pancreatitis can range from mild and self-limited to severe and fatal. A number of aspects of the condition remain poorly understood or controversial, although recent advances have improved our understanding in many areas. A substantial number of cases of "idiopathic" acute pancreatitis may be caused by occult biliary microlithiasis. The mechanism by which enzymes and bioactive substances become activated within the pancreas is a major unanswered question in acute pancreatitis; however, recent studies suggest that lysosomal enzymes within the pancreatic acinar cell may play a role. A recent refinement in computed tomography, contrast-enhanced dynamic pancreatography, has shown itself to be an extremely useful tool for detecting pancreatic necrosis and its extent, which correlates with the severity of pancreatitis and is useful in identifying patients who may have pancreatic infection and other complications. The management of acute pancreatitis includes supportive measures, observation for development of complications, and the identification of the cause of pancreatitis to prevent recurrences. Specific treatments introduced with the goal of halting the cycle of pancreatic autodigestion and benefiting the course of pancreatitis have generally proved ineffective. Early aggressive treatment of biliary pancreatitis remains controversial; however, endoscopic sphincterotomy may be helpful in more severe cases of biliary pancreatitis if there is no clinical improvement over 48 to 72 hours. Computed tomography-guided percutaneous needle aspiration appears to be a safe and reliable method for diagnosing infected pancreatic necrosis, pancreatic abscess, and infected pancreatic fluid collections.
急性胰腺炎的病情范围可从轻度且自限性到重度甚至致命。尽管近期的进展在许多领域增进了我们的认识，但该病症的多个方面仍了解不足或存在争议。大量“特发性”急性胰腺炎病例可能由隐匿性胆源性微结石引起。酶和生物活性物质在胰腺内被激活的机制是急性胰腺炎中一个主要的未解问题；然而，近期研究表明胰腺腺泡细胞内的溶酶体酶可能起作用。计算机断层扫描的一项最新改进技术，即对比增强动态胰腺造影，已证明自身是检测胰腺坏死及其范围的极其有用的工具，胰腺坏死的范围与胰腺炎的严重程度相关，且有助于识别可能发生胰腺感染及其他并发症的患者。急性胰腺炎的治疗包括支持措施、观察并发症的发生情况以及确定胰腺炎的病因以预防复发。旨在阻止胰腺自身消化循环并改善胰腺炎病程而引入的特定治疗方法总体上已证明无效。早期积极治疗胆源性胰腺炎仍存在争议；然而，如果在48至72小时内临床症状无改善，内镜下括约肌切开术可能对更严重的胆源性胰腺炎病例有帮助。计算机断层扫描引导下经皮穿刺抽吸似乎是诊断感染性胰腺坏死、胰腺脓肿及感染性胰液积聚的一种安全可靠的方法。
