Chebli J M, Martins E V, das Neves M M
Gastroenterologia Clínica da Universidade Federal de São Paulo.
Arq Gastroenterol. 1995 Oct-Dec;32(4):178-85.
The incidence of acute pancreatitis is increasing. Necrosis occurs in 10 to 20% of the cases, and is associated with great morbidity and mortality. The diagnosis of pancreatic necrosis can be suspected clinically and biochemically, and confirmed with imaging methods. A computerized tomography with contrast injection (dynamic pancreatography) is the best diagnostic method. Treatment of pancreatic necrosis is primarily conservative. Prophylactic antibiotic therapy is reserved for the biliary pancreatitis and for severe cases. When pancreatic infection is suspected, computerized tomography or ultrasonic exam guided percutaneous aspirative punction must be performed, with Gram stain and culture of the material aspirated. If bacterial infection is present, adequate antibiotic therapy with good penetration in necrotic tissue must be provided associated with surgical necrosectomy and local washing or open drainage.
急性胰腺炎的发病率正在上升。10%至20%的病例会发生坏死，且与高发病率和死亡率相关。胰腺坏死的诊断可通过临床和生化检查进行怀疑，并通过影像学方法加以证实。增强计算机断层扫描（动态胰腺造影）是最佳诊断方法。胰腺坏死的治疗主要是保守治疗。预防性抗生素治疗适用于胆源性胰腺炎和重症病例。当怀疑有胰腺感染时，必须进行计算机断层扫描或超声引导下经皮穿刺抽吸，对抽吸物进行革兰氏染色和培养。如果存在细菌感染，必须提供能有效穿透坏死组织的充分抗生素治疗，并结合手术清创和局部冲洗或开放引流。
